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First dorsal
compartment tendonitis, more commonly known as de Quervain’s
tendonitis or tenosynovitis after the Swiss surgeon Fritz de
Quervain, is a condition brought on by irritation or inflammation
of the wrist tendons at the base of the thumb. The inflammation
causes the compartment (a tunnel or a sheath) around the tendon
to swell and enlarge, making thumb and wrist movement painful.
Making a fist, grasping or holding objects—often infants—are
common painful movements with de Quervain’s tendonitis. What causes deQuervain's tendonitis? The cause of
de Quervain’s tendonitis is an irritation of the tendons
at the base of the thumb, usually caused by taking up a new,
repetitive activity. New mothers are especially prone to this
type of tendonitis: caring for an infant often creates awkward
hand positioning, and hormonal fluctuations associated with pregnancy
and nursing further contribute to its occurrence. A wrist fracture
can also predispose a patient to de Quervain’s tendonitis,
because of increased stresses across the tendons. Signs and symptoms of deQuervain's tendonitis Pain over the
thumb-side of the wrist is the main symptom. The pain may appear
either gradually or suddenly, and pain is located at the first
dorsal compartment at the wrist. Pain may radiate down the thumb
or up the forearm. Hand and thumb motion increases pain, especially
with forceful grasping or twisting. Swelling over the base of
the thumb may include a fluid-filled cyst in this region. There
may be an occasional “catching” or “snapping”
when moving the thumb. Because of the pain and swelling, motion
such as pinching may be difficult. Irritation of the nerve lying
on top of the tendon sheath may cause numbness on the back of
the thumb and index finger. Diagnosis of deQuervain's tendonitis Tenderness directly
over the tendons on the thumb-side of the wrist is the most common
finding. A test is generally performed in which the patient makes
a fist with the fingers clasped over the thumb. The wrist is
then bent in the direction of the little finger (see Figure 2
and 3). This maneuver can be quite painful for the person with
de Quervain’s tendonitis. The goal is to relieve the pain caused by the irritation and swelling. Your doctor may recommend resting the thumb and wrist by wearing a splint. Oral anti-inflammatory medication may be recommended. A cortisone-type of steroid may be injected into the tendon compartment as another treatment option. Each of these non-operative treatments help reduce the swelling, which typically relieves pain over time. In some cases, simply stopping the aggravating activities may allow the symptoms to go away on their own. When symptoms are severe or do not improve, surgery may be recommended. The surgery opens the compartment to make more room for the inflamed tendons, which breaks the vicious cycle where the tight space causes more inflammation. Normal use of the hand can usually be resumed once comfort and strength have returned.
Ganglion
cysts - Reflex Sympathetic
Dystrophy (RSD) - Carpal
Tunnel Syndrome |
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