In today’s living conditions, more than ever, our hands are strained by small repetitive movements, while the tendons of the thumb and wrist are under constant stress. De Quervain’s syndrome is a tendinitis, an inflammation of the sheath that surrounds two of the tendons that move the thumb. More specifically, De Quervain’s disease is the painful inflammation of the abductor longus and extensor brevis of the thumb, a condition in which their gliding during movements becomes more difficult, trapping them under the dorsal wrist joint. These tendons are enclosed in tendon sheaths, so their movement causes friction, causing greater thickening of the sheaths as part of a chronic degenerative process.
De Quervain’s syndrome is more common in women, possibly due to the different anatomy of the area of a bony prominence located in this area, the styloid process. It also seems to affect new mothers frequently, perhaps because they often pick up their babies in a repetitive motion with wrist resistance, with simultaneous abduction and extension of the thumb, which has been shown to be one of the most common mechanisms of challenge.
The symptoms are usually quite characteristic and consist of:
- severe pain in the area of the thumb,
- pain, tenderness and swelling on the dorsal side of the wrist,
- difficulty holding – grasping objects,
- pain which may radiate to the forearm or even cause awakening from sleep.
The diagnosis is made clinically with some special tests, such as the Finkelstein test, while an x-ray is not necessary, unless there has been a fracture in the area in the past or the appearance of the symptoms was caused after an injury. If De Quervain’s syndrome occurs after a direct blow to the wrist or forearm, or a fall on an outstretched arm, a fracture or ligamentous injury should first be ruled out. In the case of gradual onset, then initial treatment includes anti-inflammatory drugs, ice, rest, and refraining from activities that aggravate the condition.
Natural therapeutic means to control pain and swelling such as ultrasound, laser, TENS or iontophoresis are particularly effective. It is also possible to use a splint that encloses the carpometacarpal and metacarpophalangeal joint of the thumb and the wrist, which is applied continuously for the first 2-3 weeks, and as the symptoms subside, so does the time of its application.
Also, a program is followed to strengthen other muscle groups of the hand, so that the affected muscles of the thumb are not burdened, while at the same time the patient is trained in ways of holding objects, which do not aggravate the condition. Additionally, Manual Therapy and Mulligan techniques can be applied to improve joint mobility.
Finally, in cases where conservative treatment fails to eliminate the symptoms, surgical treatment is the next step, which is done with local anesthesia and aims to release the tendon sheaths and decompress the affected tendons.
