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De Quervain tendinitis also known as: tenosynovitis, syndrome or disease. De Quervain syndrome is the inflammation of the tendons of the thumb.
It is probably the most painful and debilitating hand tendinitis.
Specifics sign of De Quervain syndrome is the location of the pain (at the base of the thumb) and accentuating of this pain by the movement of the thumb.
What causes the pain?
Part of the tendons that take part in the movements of the thumb develop a swelling of their lining.
Anatomy and extensor tendon compartments - 0:31
The extensor tendons are situated on the back side of the hand grouped into 6 compartments. The dorsal carpal ligament or extensor retinaculum is a band of fibrous tissue that overlays and divides the extensor tendons into the 6 compartments.
1st compartment contains two tendons: Abductor policis longus (APL) and Extensor policis brevis (APB)
2nd compartment contains two tendons: Extensor carpi radialis longus (ECRL) and Extensor carpi radialis brevis (ECRB)
3rd compartment contains one tendon: Extensor policis longus (EPL)
4th compartment contains two tendons: Extensor indicis (EI) and Extensor digitorum comuni (EDC)
5th compartment contains one tendon: Extensor digiti minimi (EDM)
6th compartment contains one tendon: Extensor carpi ulnaris (ECU)
One of the most important and used of these is the 1st compartment also known as De Quervain. Alongside the 3rd compartment this is responsible for the extension of the thumb. The thumb is responsible for the most complex and frequent movements of the hand.
Causes of De Quervain pain - 1:43
In the 1st compartment or De Quervain compartment increase pressure is formed with the movements of the wrist and thumb, which corresponds exactly with De Quervain region.
Through overuse of these tendons (extensors of thumb and wrist) the quantity of lubricating fluid decreases and in time leads to inflammation also known as tendinitis.
De Quervain tendinitis is more common in women.
How to identify De Quervain tendinitis - 2:18
Clinical examination should include the Finkelstein test, which is a test that overstresses De Quervain region.
How to perform the test:
1. With hand in relaxed position
2. Thumb is placed into the palm
3. Thumb is grabbed by rest of fingers making a fist with the thumb in the palm
4. Patient is asked to bend the wrist towards little finger
The test is positive if there is pain in De Quervain region (base of thumb at the wrist)
Lab tests - 2:52
In the majority of cases an ultrasound scan alongside clinical examination is sufficient to confirm the diagnosis. In rare cases an x-rays or MRI scans may be required to differentiate from other possible diagnoses.
Treatment of De Quervain tendinitis - 3:11
Injection into the compartment:
A method to be considered in the initial stages of the syndrome
Dr Vladislav Gyebnar technique:
Hyaluronic acid and osmotic agent mixture injection into the 1 st compartment
Most efficient treatment is surgery.
Surgical technique:
Incision of 1 st compartment carpal ligament and releasing of the tendons within, reliving the pressure. After the release the inflammation is relieved and subsequently the pain dissipates.
The effect and benefit of surgical treatment is instantaneous.
Tip:
When the dorsal aspect of the thumb is painful and its movements are hindered we can consider De Quervain tendinitis.
It is also known by other names such as: De Quervain disease, tenosynovitis or syndrome
Because is more common is mothers who take care of infants it’s also known as mommy thumb.
Dr Vladislav Gyebnar advice:
1. If symptoms persist for multiple months or
2. If after an injectable treatment the symptoms do not go away or reappear the only recommendation is the surgical treatment
For more information about tendinopathies and tendinitis go to: www.bestetic.ro/tendinita
Important:
This is a purely educational video
It does not replace a medical consultation and does not give a definitive diagnosis.
Please consult a medical professional before making a medial decision.