Everything you need to know about Quervain’s tendonitis

Quervain’s Tenosynovitis: The Most Common Wrist Tendonitis

Also known as de Quervain’s disease or thumb tendonitis, this pathology is in fact a tenosynovitis, that is, inflammation of the synovial sheath of the tendons of the thumb. “When this sheath is inflamed, a localized inflammatory phenomenon occurs, with swelling, redness and pain,” explains the surgeon. This tenosynovitis, first described in 1985 by Dr. Frédéric de Quervain, concerns two tendons convenient at the base of the thumb : the long abductor and the short extensor, who allow thumb extension and those that run along the radius. With repeated movements, these tendons rub and their sheath becomes inflamed.

Causes: where does it come from?

Quervain’s tendonitis is a pathology caused by the repetition of mechanical gestures over a long period† It is therefore very common in many professions Where manual activities such as: secretary, laundress, seamstress, hairdresser or even gardening and knitting.

dr. Patrick Houvet, hand surgeon: This is also a common disease among young mothers, who often hold babies at arm’s length, especially to get them out of the bath.

Thus, women are affected significantly more often than men, and the age of onset is generally between 40 and 50 years.

Symptoms of thumb tendonitis

The main symptom of thumb tendonitis is: pain at the outer edge of the wrist, with a progressive appearance, which becomes sharp and disabling in a few weeks. “The pain appears as soon as the patient uses his thumb, it can radiate to the forearm and disappears when the hand is at rest,” the specialist indicates. As with all tenosynovitis, pain may be accompanied by: swelling and rednessr of the inflamed part. In its most severe forms, a loss of hand strength Can be observed.

When Quervain’s tendonitis is suspected, it is the description of the pain and the performance of two thumb maneuvers that will allow the practitioner to confirm the diagnosis.

finkelstein’s maneuver

Finkelstein’s maneuver – or test – consists of placing patient’s wrist in ulnar tiltAfter the thumb is first brought into contact with the base of the directory in the palm, the other fingers are bent over the thumb. If this maneuver causes severe pain in the patient, it is likely a sign of Quervain’s tendonitis.

The Brunelli Maneuver

On the contrary, this maneuver of Brunelli consists in: resists extension of the thumb. This time he is tense and held in kidnapping, while opposition pressure is exerted on him. Again, the test is supposed to arouse the pain so that we can go to a diagnosis of Quervain’s tendonitis.

ultrasound

However, if these two maneuvers allow one to orientate the diagnosis in a fairly certain way, there are other tendinitis that can cause essentially the same symptoms. “So we have to exclude other diagnosessuch as tendinitis of the long adductors and radials or Wartenberg syndrome,” the surgeon indicates.

ultrasound is for the reference study to confirm de Quervain’s tendonitis: it makes it possible to visualize the tendon inflammation with a thickened tendon and a fluid layer that includes the short extensor and the long abductor tendons of the thumb,” summarizes Dr Houvet.

De Quervain’s tendonitis is generally curable, in an average of 3 months with the help of medical treatment.

The Wrist Splint: How Long Should You Wear It?

The treatment of De Quervain’s tendonitis is primarily based on resting the hand, using an orthosis – commonly called a splint – ideally thermoformed. “This orthosis is worn day and night for an average of 3 weeks,” the orthopedist indicates. Oral anti-inflammatory treatment may be offered to the patient.
If the tendonitis is related to occupational activity, a work stoppage is suggested. In the case of the most stubborn tendonitis, the night device can be used for a total of 3 months.

dr. Patrick Houvet: In 80% of cases, tendonitis heals spontaneously with wearing the splint and stopping repetitive movements.

infiltrations

When wearing braces is not enough to cure tenosynovitis – as is the case in 20% of patients – infiltrations are then offered. “We realize one or two injections of corticosteroidsperformed under ultrasound in the extensor abductor brevis longus sheath”, the specialist describes. These infiltrations will allow 3/4 of the remaining patients to recover from this de Quervain tenosynovitis.

Surgery

In front of the 5% of patients with a major form resistant to orthotic and infiltration treatment, a surgical treatment has been proposed. These patients generally have somewhat unusual anatomy, with a tunnel bisected by a septum called the septum. space for the tendons and promotes friction and thus inflammation,” explains the surgeon, who indicates that the septum can be seen during the ultrasound.

The intervention is performed in ambulatory below anesthesia poor local. A skin incision less than 3 cm long and transverse to the lateral edge of the wrist allows exposure and treatment of the lesions. A splint must then be worn for 21 days after the intervention, and definitive healing is obtained after 3 months† Rehabilitation is not mandatory, but can be helpful for recovery. “The patient should massage the scar several times a day to prevent scar adhesions that can lead to tingling or burning dysesthesias,” recommends the surgeon.

The return to work will be gradual, ideally with an adjustment of posture in cases where the tendonitis was related to the professional activity.

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