De Quervain’s Tendonitis

Patient’s with De Quervain’s tendonitis have pain on the radial (thumb side) aspect of the wrist joint. There is usually a swelling on the radial aspect of the wrist. Some patients may even think that the bone at that area is “swollen”. The swelling is actually not due to bone but due to the tendon sheaths.

This condition is due to overuse of the 2 tendons that move the thumb. The friction of the 2 gliding tendons in the tight sheath causes the pain.

The 2 tendons are:

  1. Extensor pollicis brevis
  2. Abductor pollicis longus

It is common in:

  1. Women who have just delivered babies.
  2. Women between the ages of 30 to 50.

Clinical diagnostic test – Finkelstein’s test

Bend the thumb into the palm of the hand. Close the 4 fingers over the thumb. Flex the wrist downwards in the direction of the little finger. This should elicit the pain in the radial aspect of the wrist joint.

Treatment:

  1. Rest the thumb by using a thumb spica.
  2. Take oral anti-inflammatory medications.
  3. Steroid injection to the painful sheath area. There is a risk of hypopigmentation of the overlying skin. This should be comminicated to the patient before the injection.
  4. Surgery to release the tight tendon sheath.

 

 

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