De Quervain's Tenosynovitis (Tendonitis)
Tendonitis or Tenosynovitis is inflammation of tendons. It is common around the wrist and is caused by repetitive or heavy work resulting in pain and disability and limited function. De Quervain's Tenosynovitis is a specific variety of Tenosynovitis which involves the tendon at the base of thumb. It results in swelling on the thumb side of the wrist and severe pain on certain movements of the thumb. The condition can be very disabling leading to absences from work. The sheath around the tendon becomes thickened by the chronic inflammation and causes the tendon to be squeezed or constricted making the condition worse.
Pain is the main symptom and is felt along the thumb side of the wrist. The thumb itself can be painful and the pain can extend in to the forearm. Sometimes the thumb sticks during movements and clicks and grating noise can also be felt. There is also swelling over the bone on the thumb side of the wrist which is very tender to touch. After examination of the wrist the diagnosis is reached without difficulty. Passive stretch of the inflamed tendon is particularly painful. This is done by holding the thumb inside the palm and bending the wrist away from thumb (Finklstein test).
This involves rest and the use of anti-inflammatory medicines. Sometimes gels are useful in controlling the pain. This is accompanied with hand physiotherapy which involves massage, heat, gentle passive stretch and strengthening and also splint for short periods. A third of the patents respond well to this treatment.
Depomedrone or Triamcinolone, which are cortisone for local effect, is used with a local anaesthetic agent such as Lignocaine. The injection is given in the sheath of the tendon. There is some immediate relief of pain because of the local anaesthetic. The cortisone takes around 7 to 14 days to work fully. Majority of patients are helped by the injection. The injection can be repeated if necessary. Sometimes the injection can cause local area of thinning of the skin which can take many months to improve.
If the condition persists despite the above measures then surgical treatment is required. The operation is a simple release of the tendon. It is performed under local anaesthetic and takes only a few minutes. Once the tendon is released, it slowly recovers. Pain relief is good and quick. One of the complications is a sensitive scar which could take several months to improve. This is caused by either damage or scarring of a skin nerve which lies close to the tendon. Massaging the scar with a cream once or twice each day helps it to improve.
FRCS (Trauma & Orth)
Consultant Trauma and Hand Surgeon