Understanding De Quervains Syndrome

What is De Quervain’s Syndrome?

De Quervain’s syndrome is a painful condition caused by irritation of two tendons on the thumb side of the wrist. These tendons, which connect the forearm to the hand, cross the wrist joint—a highly mobile area. Tendons are anchored in tunnels or compartments, which stabilise their position on the bone and prevent displacement. A thin, lubricating tissue surrounds the tendons, allowing smooth movement through these compartments. In De Quervain’s syndrome, the compartment becomes thickened and narrows, restricting the tendons’ movement and leading to inflammation of the lubricating tissue.

What causes De Quervain’s Syndrome?

In many cases, the exact cause is unclear. While some people associate symptoms with work tasks, there is limited evidence linking the condition to specific occupations. However, jobs that require repetitive wrist and thumb movements may exacerbate pain. De Quervain’s syndrome is more frequently seen in new mothers (possibly due to hormonal changes) and in those with diabetes, thyroid disorders, or rheumatoid arthritis.

What are the symptoms of De Quervain’s Syndrome?

The primary symptoms include pain and tenderness on the thumb side of the wrist, which worsens with thumb lifting or side-to-side wrist movement. Swelling may appear at the site, and some people develop a firm lump due to compartment thickening. Occasionally, patients report clicking or snapping sensations in the tendons.

How is De Quervain’s Syndrome diagnosed?

Diagnosis is made through clinical examination, with tenderness over the compartment and pain on tendon movement usually confirming it. A test called “Finkelstein’s manoeuvre” is often used; this involves stretching the thumb tendons, which typically reproduces pain over the affected compartment.

What is the natural history of De Quervain’s Syndrome?

De Quervain’s syndrome is usually harmless and often self-limiting, typically resolving within about a year without intervention.

How is De Quervain’s Syndrome treated?

Most people can manage symptoms by adjusting how they use their hand and wrist, with no need for intensive treatment. Various options can help alleviate pain, though results vary, and some treatments have associated risks.

• • Activity Modification: Adapting movements or avoiding triggers can ease symptoms.
  • Splints: Some find relief with a splint, although others may experience discomfort in the tendon compartment.
  • Painkillers: Generally not particularly effective for De Quervain’s syndrome, so they are not typically recommended.
  • Physiotherapy: Tendon-stretching exercises can help the tendons glide more smoothly within their compartment.
  • Steroid Injections: Steroid injections are potent anti-inflammatories that may reduce pain for some time. However, they can weaken tendon tissue, and evidence does not suggest that they shorten the overall duration of the condition. Potential risks should be considered before opting for injections.
  • Surgery: In cases where compartment thickening restricts tendon movement or pain persists beyond the usual recovery time, surgery may be considered. This involves “releasing” the compartment by cutting its roof, allowing the tendons to move freely. Surgical risks include potential nerve damage, which may lead to additional complications. Most surgeries proceed without issues, but the decision should be made jointly by the patient and surgeon.