Anatomy
Passing over the back of the wrist are the tendons for muscles that extend or straighten the fingers and thumb and lift the hand at the wrist. These tendons run through six lubricated tunnels (compartments) under a thick fibrous layer called the extensor retinaculum. (Fig. 1)
The first dorsal compartment lies over the bony bump at the base of the thumb (Fig. 2). Through it passes the tendons for the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) muscles. Both muscles help spread and extend the thumb away from the rest of the hand.
Fig. 1: Anatomy of six dorsal tendon compartments
Fig. 2: Anatomy of first dorsal compartment
What Is de Quervain’s Stenosing Tenosynovitis?
De Quervain’s stenosing tenosynovitis is a painful inflammation of the tendons in the first dorsal compartment of the wrist.
The lubricating synovial sheath lining this compartment thickens and swells, giving the enclosed tendons less room to move, and producing extra synovial fluid. A painful cyst may also form in this area because of the increased tissue in the compartment.
What Are the Causes, and Who Is at Risk?
This inflammation may be caused by any condition that changes the shape of the compartment or causes swelling or thickening.
De Quervain’s stenosing tenosynovitis occurs most often in individuals between the ages of 30 and 50. Women are afflicted with this condition eight to ten times more often than men. People who engage in activities requiring sideways wrist motion while gripping the thumb, like hammering, skiing, and some assembly line jobs, may be predisposed to developing this disorder.
Signs and Symptoms
Pain over the thumb side of the wrist is the primary symptom. This condition may occur “overnight” or very gradually, radiating pain into the thumb and up the forearm. It worsens with the hand and thumb, especially with any forceful grasping, pinching, or twisting.
Swelling over the thumb side of the wrist may be present, and some “snapping” when the thumb is moved may occur. Because of the pain and swelling, there may be some decreased thumb motion.
Besides pain and swelling over the first dorsal compartment, having a positive Finkelstein’s test indicates the patient has this problem (Fig. 3). In this test, the patient makes a fist with their thumb placed under the fingers. Then the patient bends the wrist away from the thumb and towards the little finger side of the hand. This test is mildly painful to most people, but to someone with de Quervain’s stenosing tenosynovitis.
Besides pain and swelling over the first dorsal compartment, having a positive Finkelstein’s test indicates the patient has this problem (Fig. 3: Finkelstein’s Test). In this test, the patient makes a fist with their thumb placed under the fingers. Then the patient bends the wrist away from the thumb and towards the little finger side of the hand. This test is mildly painful to most people, but to someone with de Quervain’s stenosing tenosynovitis.
Conservative Management
Your doctor may first try to reverse the course of the disease with a three- to six-week trial of anti-inflammatory medication. At the same time, you’ll rest your wrist and thumb by wearing a wrist and thumb spica splint. Your physician may also inject the area with a small amount of steroid to help decrease the inflammation.
If Surgery Is Necessary
If de Quervain’s stenosing tenosynovitis symptoms are long-standing or unresponsive to conservative management, surgery is indicated. This type of surgery is usually performed on an outpatient basis.
During surgery, an incision is made over the first dorsal compartment. The ligament that makes up the tunnel’s roof is cut to release the APL and EPB tendons. The wound is then closed, and a compressive dressing is applied.
What to Expect Following Surgery
Your surgeon will provide a prescription for pain medication. The bulky dressing is removed within 5 - 14 days after surgery, and an exercise program for the thumb and wrist is started. It usually takes several weeks for a full recovery. De Quervain’s stenosing tenosynovitis rarely recurs after proper surgical intervention.
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