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  • De Quervain's Tenosynovitis

    (De Quervain’s Syndrome; De Quervain’s Disease; Washerwoman’s Sprain)

    Definition

    De Quervain's tenosynovitis is an inflammation of the sheaths (tenosynovium) of the tendons that move the thumb up and out (away from the hand). It is technically referred to as a stenosing tenosynovitis . Both the tendons and their surrounding tissue sheaths are involved in the area where the tendon has to go through a small tunnel of bony and fibrous tissue at the wrist. The inflamed tenosynovium becomes painful at the tunnel area.
    Like tennis elbow and carpal tunnel syndrome , it is a condition often brought about by overuse. In this case, a wringing action of the wrists is most frequently responsible. It is sometimes called “washerwoman’s sprain.”
    It is far more common in women than in men. It is not associated with any systemic disease or dangerous condition. It usually requires medical treatment to resolve.
    De Quervain's Tenosynovitis
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    Copyright © Nucleus Medical Media, Inc.

    Causes

    De Quervain’s is a mechanical problem caused by repetitive use of the thumb and wrists.

    Risk Factors

    The most common way to get De Quervain’s tenosynovitis is by certain repetitive movements of your hands and wrists. A direct blow to the area may also cause the condition. Common repetitive motions that can lead to this include:
    • Knitting and needlepoint
    • Lifting a baby or young child often
    • Bowling

    Symptoms

    Wrist pain may be due to several conditions other than De Quervain’s tenosynovitis. If your wrist is hurting, see your physician.
    A symptom of De Quervain’s tenosynovitis is pain in the wrist below the thumb that worsens with use.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You maybe referred to an orthopedic surgeon for treatment.
    The definitive diagnosis of De Quervain’s tenosynovitis is the Finkelstein test:
    Curl your fingers over your thumb (make a fist with your thumb inside your fingers) and bend your wrist toward your little finger. If this causes pain at the wrist below your thumb, you may have De Quervain's tenosynovitis.

    Treatment

    Talk with your doctor about the best treatment plan for you. Treatment options include the following:

    Conservative Measures

    Rest, splinting, cold packs, and over-the-counter pain relievers may provide relief in some people.

    Cortisone Injection

    An injection of a cortisone-like drug into the tendon sheath is 70% to 90% effective in curing the condition.

    Surgery

    When all else fails, an orthopedic surgeon will open up the small tunnel of bony and fibrous tissue and possibly remove some of the tendon sheath. This will allow the tendon(s) more room to move.

    Prevention

    To help reduce your chances of getting De Quervain's, minimize twisting and gripping activities.

    RESOURCES

    American Academy of Orthopedic Surgeons http://www.aaos.org

    The American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Physical Therapy Canada http://www.physicaltherapy.ca/

    References

    Best treatment for de Quervain's tenosynovitis uncertain. Am Fam Physician. 2003;68(3):536. Available at: http://www.aafp.org/afp/2003/0801/p536.html . Accessed January 2, 2013.

    Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract . 2003;16(2):102-6.

    de Quervain tenosynovitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated July 13, 2011. Accessed January 2, 2013.

    Johnson CA. Occurrence of de Quervain's disease in postpartum women—pain and tenderness in wrist. J Fam Pract . 1991 Mar;32(3):325-7.

    Revision Information

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