Quervain’s tenosynovitis: the most common wrist tendonitis
Also known as de quervain’s disease or tendonitis of the thumb, this pathology is in fact a tenosynovitis, that is, inflammation of the synovial sheath of the tendons of the thumb. “When this sheath is inflamed, a local inflammatory phenomenon is created, with swelling, redness and pain” explains the surgeon. Described for the first time in 1985 by Dr Frédéric de Quervain, this tenosynovitis concerns two tendons located at the base of the thumb : the long abductor and the short extensor, which allow thumb extension and which run along the radius. During repeated movements, these tendons rub and their sheath is inflamed.
Causes: what is it due to?
Quervain’s tendinitis is a pathology caused by the repetition of mechanical gestures over a long period. It is therefore very common in many occupations Where manual activities such as: secretary, laundress, dressmaker, hairdresser or even gardening and knitting.
Dr. Patrick Houvet, hand surgeon: This is also a common disease in young mothers, who often hold babies at arm’s length, especially to take them out of the bath.
Women are thus significantly more affected than men, and the age of onset is generally between 40 and 50 years old.
Symptoms of thumb tendonitis
The main symptom of thumb tendinitis is pain at the outer edge of the wrist, of progressive appearance, which becomes in a few weeks sharp and disabling. “The pain appears as soon as the patient uses his thumb, it can radiate into the forearm, and it disappears when the hand is at rest” indicates the specialist. As with all tenosynovitis, the pain may be accompanied by swelling and rednessr of the inflamed part. In the most severe forms, a loss of hand strength can be observed.
When quervain’s tendinitis is suspected, it is the description of the pain and the performance of two thumb mobilization maneuvers that will allow the practitioner to confirm the diagnosis.
Finkelstein’s maneuver – or test – consists of placing the patient’s wrist in ulnar tilt, after first putting the thumb in contact with the base of the directory in the palm of the hand, the other fingers are flexed above the thumb. If this maneuver causes severe pain in the patient, it is likely a sign of Quervain’s tendonitis.
The Brunelli maneuver
This Brunelli maneuver consists on the contrary in oppose extension of the thumb. This one is this time tense, and maintained in abduction, while one exerts on him a pressure of opposition. Here again, the test must wake up the pain so that we can move towards a diagnosis of tendinitis de Quervain.
If these two maneuvers make it possible to orient the diagnosis in a fairly sure way, there are however other tendinitis which can cause substantially the same symptoms. “So you have to rule out other diagnosessuch as tendonitis of the long adductor and radials or Wartenberg syndrome” indicates the surgeon.
“Ultrasound is for the reference examination to confirm de Quervain’s tendinitis: it makes it possible to visualize the tendon inflammation with a thickened tendon and a fluid layer encompassing the short extensor and long abductor tendons of the thumb” summarizes Dr Houvet.
De quervain’s tendonitis is generally cured well, in an average of 3 months with the help of medical treatment.
The wrist splint: how long to wear it?
The treatment of De Quervain’s tendonitis is based primarily on resting the hand, using an orthosis – commonly called a splint – ideally thermoformed. “This orthosis will be worn day and night for an average of 3 weeks” indicates the orthopedist. Oral anti-inflammatory treatment may be offered to the patient.
If the tendinitis is related to the professional activity, a work stoppage is proposed. The night appliance can be kept for a total of 3 months for the most stubborn tendinitis.
Dr. Patrick Houvet: In 80% of cases, tendonitis heals spontaneously with the wearing of the splint and the cessation of repetitive movements.
When wearing a brace is not enough to cure tenosynovitis – as is the case for 20% of patients – infiltrations are then offered. “We realize one or two corticosteroid injectionsperformed under ultrasound inside the extensor abductor brevis longus sheath” describes the specialist. These infiltrations will allow 3/4 of the remaining patients to recover from this de Quervain tenosynovitis.
For the 5% of patients with a major form which resists treatment by orthosis and infiltration, a surgical treatment is proposed. “These patients generally have a somewhat unusual anatomy, with a tunnel divided in two by a partition called the septum. On one side of the partition is the tendon of the long abductor and on the other the tendon of the short extensor, which leaves less room for the tendons and promotes friction and therefore inflammation” explains the surgeon, who specifies that the septum is seen during the ultrasound.
The intervention is performed in ambulatory under anesthesia arm local. A skin incision less than 3 cm long and located transversely at the lateral edge of the wrist allows the lesions to be exposed and treated. A splint must then be worn for 21 days after the intervention, and final cure is obtained after 3 months. Rehabilitation is not compulsory but it can be useful for recovery. “The patient must massage the scar several times a day to avoid scar adhesions which can lead to tingling or burning dysesthesias” recommends the surgeon.
The return to work will be done gradually, ideally with an adjustment of the position in cases where the tendinitis was linked to the professional activity.