The wrist forms a flexible connection between the forearm and the hand. It has the task of optimally positioning the hand to perform fine motor activities. In addition, its position maintains an optimal length-tension ratio in the long muscles of the fingers, so that they do not fall into active failure. The thumb is located perpendicular to the other fingers and is the most mobile. This allows him to oppose the other fingers when performing different grips. As the hand is also an important sensory organ, damage to the wrist and thumb would limit the functionality of the entire upper limb. De Quervain’s tenosynovitis occurs as a result of repetitive microtrauma and overexertion and slowly and gradually affects functionally and later structurally the function of the thumb and wrist.
The muscular tendons that run along the dorsal surface of the wrist are retained by the extensor retinaculum. Between it and the dorsal surface of the wrist are 6 fibrous tunnels, through which pass the tendons of the extensors of the wrist and its synovial membranes. This mechanism prevents the tendons from separating from the wrist during muscle contraction while strengthening and stabilizing. De Quervain’s tenosynovitis is associated with pain, swelling, and limited movement, affecting the muscles of the thumb and, more specifically, the tendons of the long extensor and short extensor, located in the first dorsal canal of the wrist. The disease is also called stenotic tenosynovitis and mainly affects middle-aged women as well as active athletes.
Symptoms and diagnosis
The monotonous movements irritate the synovial vagina of both tendons. It becomes inflamed, swollen and thickened. Gradually, the first osteofibrous canal narrows, which compromises the slippage of the tendons located in it. The area is swollen and red, and the movements of the wrist and thumb are painful and limited. Pain can also affect the forearm.
De Quervain’s diagnosis of tenosynovitis is made after examination by an orthopedist on the basis of a detailed history and palpation. To accurately diagnose, the patient’s symptoms are provoked by the Finkelstein test. In it, the patient brings his thumb to the palm, presses it in the other fingers and takes it ulnar. This stretches the affected tendons in the canal and provokes the appearance of pain.
Treatment of De Quervain’s tenosynovitis
Treatment can be conservative and operative. Conservative treatment is recommended at an early stage of tenosynovitis. It consists of topical application of nonsteroidal anti-inflammatory drugs and physiotherapy and kinesitherapy. Physiotherapy procedures include low-frequency electrotherapy, ultrasound, laser therapy, manual therapy, and building a set of exercises to improve tendon slippage and wrist stabilization.
Surgical treatment is recommended as a last resort in case of ultimate failure of other therapeutic activities. It consists of longitudinal incision of the extensor retinaculum and dissolution of the fibrous canal.