De Quervain’s Disease
What is De Quervain’s disease?
De Quervain’s disease is a painful clinical condition caused by inflammation and swelling of the tendons of the thumb at the level of the wrist. The swollen tendons and their sheaths (tenosynovium) are trapped in narrow tunnels where they pass through, causing the thumb and wrist movements to become painful and restricted.
What are the causes of De Quervain’s disease?
- Overuse, repetitive stresses, heavy lifting activities and some inflammatory diseases such as rheumatoid arthritis may initiate the disease
- Occupations such as gardening and some compelling sports such as tennis can cause De Quervain’s disease
- Baby care activities such as carrying, taking a lap may cause to develop De Quervain’s disease in new mothers / grandmothers.
What are the complaints in De Quervain’s disease?
- There is pain over the tendons of the thumb at the level of the wrist.
- The pain can spread through out the thumb.
- Thumb and wrist movements become difficult during daily life.
- A swelling at the painful site may be recorded.
- Pain can be increased by pressing over the swelling, during hand and thumb movements or during grasping and rotational movements.
How to Diagnose De Quervain’s Disease?
- The location of the pain during the examination raises suspicion.
- Pain exacerbates once the thumb is pulled into the palm and then the wrist bends towards the side of the little finger. This finding is diagnostic for the diagnosis of De Quervain’s tenosynovitis.
- Rarely, magnetic resonance imaging may be required.
How to Treat De Quervain’s Disease?
Treatment usually begins with the use of a splint that immobilize wrist and the thumb. Ice can be applied to reduce inflammation. If complaints persist, it is attempted to reduce the inflammation and thus relieve the pain by taking anti-inflammatory drugs orally or by applying locally. Physical therapy methods can be used. Despite all conservative treatment modalities, if De Quervain’s tenosynovitis persists, surgical procedures may be necessary.
De Quervain surgery is usually an out-patient operation. In surgery, the tunnel where the tendons are stuck, is released and decompressed. Thus, the pain due to the friction of the tendons is eliminated and the thumb movements are facilitated. Thumb and wrist exercises begin immediately after the operation. Stitches are taken out after 12-14 days. The recovery period takes about 3-4 weeks, although it differs in each patient, depending on the patient’s age, general health status, the severity of the complaints, and the time elapsed since the time of onset. Heavy work and compelling activities are not recommended for 4-6 weeks. Postoperative physical therapy may be necessary.
Prof. Dr. Eftal Gudemez
Orthopedics and Traumatology
Hand Surgery and Microsurgery
