De Quervain’s stenosing tendovaginitis

Quervain’s disease (Tendovaginitis stenosans de Quervain) describes an inflammation of the tendon sheath of the short extensor and long spreader of the thumb.

Extension (extension) and abduction (movement away from the index finger) of the thumb are primarily enabled by two muscles that originate in the forearm and feed into the first finger: the long thumb spreader (abductor pollicis longus muscle) and the short thumb extensor (extensor pollicis muscle). breviary).

The tendons of these two muscles run in a fibrous sheath, which has the task of reducing the friction that occurs during movement. Tendons and tendon sheaths lie in a canal bounded by the carpal bones and the extensor retinaculum; this is a transverse band to the tendons, which they pass through in the first tendon compartment.

Inflammation of the tendon sheath leads to an increase in its volume and a narrowing (stenosis) of the interior space through which the tendons pass, causing them to be compressed.
The stenosis that forms in the transverse ligamentous canal of the wrist (also known as the first tendon compartment) can become a visible bump and further limit movement of the tendons.
In Quervain’s disease, the movement of the thumb creates a lot of friction as the tendon rubs against the inner wall, causing the inflammation to rekindle itself.


What are the causes of Quervain’s disease?

The tendonitis of the short extensor and long spreader of the thumb mainly affects women between the ages of 45 and 65.
The predisposition to tendinopathies also plays a major role in hand tendinitis; in fact, within a very short space of time, the same patient may also visit the doctor for trigger finger or carpal tunnel syndrome .

In men, the disease occurs primarily in those who engage in athletic or physical activities with repetitive hand movements, leading to tendon overload in the thumb and wrist area.

Making music, crocheting and computer work are activities that are a common cause of Quervain’s disease.
After childbirth, mothers have hormonal imbalances caused by pregnancy ; Add to this the stress of picking up and holding the baby, and the eyes can become inflamed.

While a post-traumatic cause is rare, it is quite possible for this condition to develop as a result of a fall.

What are the symptoms of de Quervain’s stenosing tendonitis?

The symptoms of Quervain disease are pain, swelling and edema at the level of the wrist where the thumb extensor tendon sheaths pass.
The visible swelling is not increased bone volume, as many patients assume, but fluid from the inflammation.
As with any tendinitis, the pain occurs when pressing on the affected area and when stretching the tendon.
Symptoms are felt in the wrist, but shooting pain can extend to the dorsum of the thumb or radiate to the forearm.
The pain can also occur at night when sleeping on the hand, or the discomfort is worse in the morning; some patients complain of tinglingin the thumb.
Particularly painful movements are: turning the key, opening a bottle or can, holding a pan, pouring off water while cooking, etc.

How is Quervain’s disease diagnosed?

Diagnosis is mainly clinical; the doctor examines the patient’s medical history, which often reveals the risk factors and typical age for onset.
Then he will feel the extensor tendons of the thumb to see if the pain increases as a result.
The typical movement test used to detect Quervain’s disease is called the Finkelstein test; it consists of making a fist with the thumb in the hand under the other fingers and bending the wrist towards the little finger.
If this “stretching” of the tendon sheaths of the short extensor and long spreader of the thumb causes severe pain in the area of ​​the wrist near the thumb, the test is positive.
The differential diagnosis is made with other musculoskeletal disorders in this area: scaphoid fracture , radial fracture ,  arthrosis between the carpal bones and radius or rhizarthrosis.

Usually, a visit to a specialist (physiatrist or orthopedist) is enough to diagnose Quervain’s disease; they can order an ultrasound scan to better assess the condition of the tendon.
An X-ray is only useful to rule out fractures or inflammation caused by osteoarthritis.

What is the right therapy for de Quervain stenosing tendovaginitis?

If the pain is recent and tolerable, pharmacological treatment with anti-inflammatory drugs can be started; It is also useful to use a splint or support bandage to immobilize the thumb and wrist.

Kinesio taping for rhizarthrosis, Quervain’s disease, sprain of the thumb joint

Effect: draining. Shape: an ”I” stripe. Length: 15-20cm. Anchor the strip to the thumbnail using a hole. Apply the band without tension with the thumb flexed, following the path of the spoke dimple (short thumb extensor and long thumb introducer).

If these measures are not sufficient, cortisone injections and manual therapy can be used; the latter eliminates the cause of the complaints.
If all conservative treatment methods are insufficient, surgical intervention can be performed.
Surgery for Quervain’s disease involves opening the tendon sheath and cleaning the tissue.
The procedure is usually performed on an outpatient basis under local anesthesia and takes only 15 minutes.
Follow-up treatment is not required if the operation was successful and the patient was in good condition before the operation.

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