De Quervains tenosynovitis

Named after a Swiss surgeon, who described the condition in 1895, De Quervain's tenosynovitis is an inflammatory condition of two specific tendons which pass around the corner of the wrist as they leave the forearm to enter the base of the thumb.

De Quervain's tenosynovitis is characterised by a relatively rapid onset of pain around the thumb-side of the wrist. Whilst this pain is felt as a constant ache at rest, it rapidly increases in severity on movement of the thumb. A tender swelling is often evident.

The two tendons (abductor pollicis longus, APL, and extensor pollicis brevis, EPB) course through a tight tunnel to prevent them slipping off the edge of the wrist as it bends up and down. The tendons need to be lubricated for free movement, so have a highly vascular covering which allows this. This covering can become inflamed, often for no specific reason, giving rise to the typical symptoms of De Quervain's tenosynovitis.

It is difficult to prove that there is a link between this condition and any particular activity, injury or work practice. It often seems to come on for no apparent reason, although is mostly seen in women, especially between the ages of 30 and 50 years.

The most painful movements would be active thumb 'abduction' (moving the thumb away from the hand such as when opening a pair of scissors) and passively bending the thumb across the palm. Pain on this latter movement is thought to be diagnostic of this condition. This test bears the name of the American surgeon who described it in 1930, Harry Finkelstein.

Sometimes, the pain and inflammation will ease over time, but it is usually necessary to seek treatment. Resting the wrist and thumb in a prefabricated splint will provide some relief, but it is often necessary to undergo an injection of steroid (cortisone) to hasten resolution of the inflammation.

In rare or recurrent cases, injections no longer prove effective. Surgery to release the tendon tunnel is carried out under a local anaesthetic through a small 1 cm scar. This type of surgery does not always remove the pain so should be reserved for people in whom all other treatments have failed, yet in whom the symptoms are still disturbing.

For further, more detailed information, use this link to the website of the British Society for Surgery of the Hand

De Quervains