De Quervain
What is De Quervain’s disease and what causes it?
De Quervain’s disease, or De Quervain’s tenosynovitis, is an inflammatory condition affecting the tendons located in the first dorsal compartment of the wrist. Under normal conditions, these tendons glide smoothly within their sheath. However, repetitive thumb movements or acute trauma may lead to inflammation and swelling in the area. As a result, the tendons become compressed, impairing their normal motion. The overuse of the thumb, particularly involving extension, flexion, and rotational movements, is considered the primary cause of this condition.
It most commonly affects women over the age of 40 and individuals involved in occupations requiring repetitive manual tasks. In some cases, the exact etiology remains unclear.
What are the symptoms of De Quervain’s disease?
The hallmark symptom is pain at the base of the thumb, extending into the wrist. This pain intensifies during gripping or twisting movements. If inflammation persists, even simple thumb motions become painful, significantly limiting the patient’s ability to perform daily activities. In advanced stages, the tendons may become entrapped or immobile due to the surrounding edema. These symptoms typically arise after a period of overuse and, if left untreated, may persist for weeks or even months. Early evaluation by an orthopedic specialist is crucial for accurate diagnosis and timely treatment.
How is De Quervain’s disease diagnosed?
Diagnosis is primarily clinical, based on patient history and physical examination. An orthopedic surgeon can often confirm the diagnosis through palpation of the affected area, which reproduces pain along the tendons. A commonly used diagnostic maneuver is the Finkelstein test, in which the thumb is flexed into the palm and the wrist is deviated ulnarly. A positive test, characterized by sharp pain, is highly indicative of De Quervain’s tenosynovitis.
Imaging studies are generally not necessary for diagnosis unless there is a need to exclude other sources of wrist pain.
What are the treatment options for De Quervain’s disease?
In its early stages, De Quervain’s tenosynovitis is managed conservatively through the following measures:
- Rest and activity modification
- Avoidance of strenuous thumb and wrist movements
- Administration of non-steroidal anti-inflammatory drugs (NSAIDs)
- Application of a thumb spica splint to immobilize the area
- Corticosteroid injection may be considered, but it must be performed exclusively by an orthopedic specialist, as improper administration may injure the nearby superficial radial nerve, which poses a significant risk.
- PRP (Platelet-Rich Plasma) injection: This is a modern, non-surgical treatment option offering dual benefits—potent anti-inflammatory effects and regenerative healing, making it highly effective in managing tendinopathies such as De Quervain’s.
If symptoms persist despite conservative treatment, surgical intervention becomes necessary. This procedure is performed under local anesthesia through a 2 cm incision over the dorsal wrist compartment. It is an outpatient procedure, and patients can mobilize their hand immediately afterward. Return to normal activities is generally expected within two weeks postoperatively.
Surgical outcomes are excellent, particularly when performed by a specialist orthopedic surgeon, with immediate symptom resolution and a low likelihood of recurrence.
