De Quervain’s Disease is a painful tendinitis that develops at the base of the thumb at the wrist level. A Swiss surgeon, Fritz de Quervain, first described this problem in 1895.
Numerous tendons pass across the wrist to the thumb. Two of these tendons, the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL), help spread and extend the thumb away from the rest of the hand. They are necessary for a powerful grasp and also help to move the wrist. These tendons are restrained at the wrist by a retinaculum called the first dorsal compartment. Inflammation of these two tendons as they pass through the first dorsal compartment – De Quervain’s Tenosynovitis – can be extremely painful and disabling.
This inflammation may be caused by anything that changes the shape of the compartment or causes swelling or thickening of the tendons. Repetitive trauma, overuse or inflammatory processes are the most common causes.
De Quervain’s stenosing tenosynovitis occurs most often in individuals between 30 and 50 and occurs more in women. People who engage in repetitive activities requiring side-to-side motion of the wrist while gripping the thumb – as in hammering, skiing and some assembly jobs – may develop the disorder. It is also commonly seen in new mothers, perhaps as a result of repetitive infant lifting.
Pain, often severe over the thumb side of the wrist, is the primary symptom. It may develop rapidly or gradually, and it may radiate into the thumb and up the forearm. It is worse with the use of the hand and thumb, especially with any forceful grasping, pinching or twisting. Swelling over the thumb side of the wrist may be present. This pain may limit thumb motion. Nearly all patients with this problem will have a positive Finkelstein’s test. In this test, the thumb is placed in the palm and the fingers are then forcefully wrapped around the thumb; the wrist is then deviated to the small finger side. Severe pain indicates a positive test.
There are several treatment options. Very mild cases can be treated with splinting and anti-inflammatory medications. More severe cases may require a steroid injection within the first dorsal compartment in addition to splinting. Severe or refractory cases may require surgery. The surgical treatment is based on expanding the size of the first dorsal compartment.
