De Quervain’s Tenosynovitis

Definition/diagnostic criteria De Quervain’s tenosynovitis is a condition characterised by pain and tenderness at the radial side of the wrist, often associated with swelling. It is caused by inflammation of the sheath containing the abductor pollicis longus and extensor pollicis brevis tendons. Diagnostic criteria include pain on thumb movement and tenderness over the radial styloid. The Finkelstein test, where pain is elicited by ulnar deviation of the wrist while the thumb is held within a fist, is commonly used for diagnosis.

Epidemiology This condition predominantly affects middle-aged individuals, with a higher incidence in women. There is a notable association with activities involving repetitive hand and wrist movements. Additionally, it is frequently seen in postpartum women, possibly due to hormonal changes and increased wrist strain from infant care.

Diagnosis
Clinical features: The primary clinical feature is pain at the radial side of the wrist, which can radiate to the thumb or forearm. Swelling and difficulty in thumb movement are also common. Patients often report pain exacerbation with activities involving thumb and wrist movement. Finkelstein’s test is positive.

Investigations: Diagnosis is primarily clinical. Imaging, such as ultrasound or MRI, is rarely required but may be used in atypical cases to rule out other pathologies. Ultrasound may show thickening of the involved tendons and their sheaths.

Treatment Treatment aims to reduce pain and inflammation, and restore function. Initial management includes:

• Rest and activity modification to avoid movements exacerbating symptoms.
• Analgesics: NSAIDs, such as ibuprofen, can be prescribed for pain and inflammation control. Care should be taken with their use in individuals with contraindications.
• Splinting: A thumb spica splint can be used to immobilise the thumb and wrist, reducing tendon irritation.
• Corticosteroid injections: Injection into the tendon sheath may provide significant symptom relief. This should be considered if symptoms are not controlled with conservative measures.
• Physiotherapy: Exercises to stretch and strengthen the wrist and thumb may aid recovery.

Surgical intervention, involving the release of the tendon sheath, is considered if conservative treatments fail.

Prognosis The prognosis is generally good with conservative treatment. Most patients experience significant symptom relief with non-surgical measures. However, symptoms can persist in some cases, necessitating surgical intervention. Post-surgery, the majority of patients achieve good functional outcomes and symptom resolution.