De Quervain's Tenosynovitis
What is De Quervain's Tenosynovitis?
Symptoms of De Quervain’s Tenosynovitis:
The main symptoms include:
- Pain and Swelling: Pain at the base of the thumb, near the wrist, that may radiate into the thumb or the forearm. The area may also appear swollen.
- Pain with Thumb Movement: Pain is often aggravated by thumb movements, such as grasping or pinching. It may also be triggered by activities like twisting the wrist or lifting objects.
- Limited Range of Motion: It may become difficult to fully move the thumb, especially during abduction or extension.
- Tenderness: The affected area (at the base of the thumb) may be tender to touch.
- A “Catch” or “Snapping” Sensation: Some people experience a sensation of the tendons catching or snapping as they move, which is often referred to as a “creaking” or “snapping” feeling in the wrist or thumb.
Treatment We Offer:
An ultrasound-guided cortisone injection is an effective treatment for De Quervain’s tenosynovitis when conservative measures (rest, splinting, NSAIDs, etc.) fail to provide sufficient relief. This technique involves using ultrasound imaging to guide the precise placement of a cortisone injection (a corticosteroid medication) directly into the affected tendon sheath to reduce inflammation and relieve pain.
How the Procedure Works:
Ultrasound Guidance:
- The clinician uses ultrasound imaging to visualize the tendons and surrounding structures in real-time. This allows them to accurately locate the first dorsal compartment, where the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons are inflamed due to De Quervain’s tenosynovitis.
- The ultrasound ensures that the injection is placed precisely in the correct area (the tendon sheath) to maximize effectiveness and minimize the risk of complications.
Cortisone Injection:
- Cortisone is a potent anti-inflammatory medication that can help reduce swelling, decrease pain, and promote healing in the inflamed tendons and their sheaths.
- The clinician injects the cortisone into the affected area, typically the tendon sheath around the APL and EPB tendons, where the inflammation is concentrated.
Benefits of Ultrasound-Guided Cortisone Injection for De Quervain’s:
Precision: The ultrasound allows the clinician to see the tendon and the surrounding tissues in real-time, ensuring the cortisone is injected directly into the area that needs treatment. This can significantly enhance the success of the injection and reduce the likelihood of the medication being injected into the wrong area.
Reduced Risk: Using ultrasound guidance minimizes the risk of damaging nearby structures, such as nerves and blood vessels, since the clinician can visually monitor the needle placement.
Fast Relief: A cortisone injection typically provides rapid pain relief for many patients, with the effects often beginning within a few days to a week.
Non-invasive: The procedure is minimally invasive and can be done in a clinical or outpatient setting, requiring only a small needle insertion.
Your Care Pathway with us
Your Care Pathway with us
- To book an appointment you can call our reception line, 0142084487, or email to info@altonpainclinic.co.uk or click the button given below.
- Comprehensive Musculoskeletal examination and testing.
- Same day Ultrasound Guided Injection for pain relief.
- Discussion of your treatment plan, treatment plan can include advanced treatments for example Cortisone Injections, Hyaluronic injections and various other options tailored to your specific needs.
Anatomy
Anatomy of De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis involves inflammation of the tendons and synovial sheath in the first dorsal compartment of the wrist. To better understand this condition, let’s break down the relevant anatomy:
Key Structures Involved in De Quervain’s Tenosynovitis:
First Dorsal Compartment:
- The first dorsal compartment is a narrow tunnel located on the radial (thumb) side of the wrist.
- This compartment houses two tendons: the Abductor Pollicis Longus (APL) and the Extensor Pollicis Brevis (EPB).
- These tendons are responsible for important thumb movements: abduction (moving the thumb away from the hand) and extension (straightening the thumb).
Abductor Pollicis Longus (APL):
- The APL is a muscle that originates from the radius (one of the forearm bones) and the interosseous membrane (tissue between the radius and ulna) and inserts into the base of the first metacarpal (thumb bone).
- Its primary function is abducting the thumb, i.e., moving the thumb away from the hand, as well as contributing to thumb extension.
Extensor Pollicis Brevis (EPB):
- The EPB originates from the radius and the interosseous membrane, like the APL. It inserts at the base of the proximal phalanx of the thumb.
- Its function is to extend the thumb at the metacarpophalangeal (MCP) joint, which is the joint that connects the thumb to the rest of the hand.
Synovial Sheath:
- Both tendons (APL and EPB) are surrounded by a synovial sheath, which is a fluid-filled sac that allows smooth gliding of the tendons as they move.
- In De Quervain’s tenosynovitis, this sheath becomes inflamed, causing thickening, swelling, and friction between the tendons.
Tendons and Their Function:
- Both the APL and EPB are critical for thumb movement and the function of the hand. The APL is responsible for pulling the thumb away from the palm (abduction), while the EPB helps extend the thumb out straight.
Pathophysiology of De Quervain’s Tenosynovitis:
In De Quervain’s tenosynovitis, repetitive motion or overuse of the thumb (such as gripping, pinching, or twisting) causes inflammation of the tendons and their synovial sheaths within the first dorsal compartment. This leads to:
- Swelling and Thickening: The sheath surrounding the tendons becomes thickened due to inflammation.
- Pain and Stiffness: As the tendons and their sheath become swollen, friction increases, leading to pain, especially when moving the thumb.
- Limited Range of Motion: The inflammation and swelling can restrict the movement of the thumb, making it painful and difficult to perform actions such as grasping, lifting, or pinching.
What is De Quervain’s Tenosynovitis?
De Quervain’s Tenosynovitis is a painful condition that affects the tendons on the thumb side of the wrist. It involves inflammation of the tendons and their surrounding synovial sheath (the protective lining that surrounds the tendons) in the first dorsal compartment of the wrist. This inflammation leads to pain, swelling, and difficulty moving the thumb and wrist.
Key Structures Involved:
- Tendons Affected: The two tendons most commonly involved are the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB). These tendons control the movement of the thumb, such as abduction (moving the thumb away from the hand) and extension (straightening the thumb).
- Synovial Sheath: The tendons are encased in a synovial sheath, which normally helps them glide smoothly. In De Quervain’s tenosynovitis, this sheath becomes irritated and thickened due to inflammation.
Causes:
The main cause of De Quervain’s tenosynovitis is overuse or repetitive motion of the thumb and wrist, leading to irritation of the tendons and their sheaths. Common activities that may trigger or worsen the condition include:
- Repetitive gripping (e.g., lifting heavy objects or using tools)
- Pinching motions (e.g., using a smartphone, typing)
- Twisting motions (e.g., wringing out a towel)
- Caring for infants (holding babies for long periods, which often involves repetitive movements)
Other risk factors include:
- Pregnancy, particularly in the postpartum period, due to hormonal changes and increased strain on the wrist.
- Age and Gender: The condition is more common in women than men, especially between 30-50 years of age.
- Rheumatoid arthritis or other inflammatory conditions can also increase the risk.
Diagnosis:
A physical exam by a clinician is typically enough for diagnosing De Quervain’s. The Finkelstein test is commonly used:
- The patient makes a fist with the thumb inside the fingers and then bends the wrist towards the little finger. If this causes pain over the thumb side of the wrist, it is a positive sign of De Quervain’s tenosynovitis.
Ultrasound imaging may be used to confirm the diagnosis or rule out other conditions.
Treatment:
Treatment for De Quervain’s tenosynovitis generally focuses on reducing inflammation and relieving pain. Common treatment options include:
- Rest: Avoiding activities that cause pain or strain on the thumb and wrist.
- Splinting: Wearing a splint or brace to immobilize the wrist and thumb can help reduce movement and give the tendons a chance to heal.
- Ice: Applying ice to the affected area can reduce swelling and pain.
- Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce inflammation and alleviate pain.
- Corticosteroid Injections: If symptoms do not improve with conservative treatment, a cortisone injection may be given directly into the tendon sheath to reduce inflammation.
- Physical Therapy: Once inflammation has reduced, stretching and strengthening exercises can help restore function and prevent recurrence.
- Surgery: If other treatments fail, a small surgery called tenosynovectomy may be performed to release the inflamed tendon sheath and relieve pressure.
Prevention:
To reduce the risk of developing De Quervain’s:
- Ergonomic adjustments: Change your workspace setup to reduce strain on the wrists.
- Take frequent breaks: If doing repetitive tasks, take breaks to rest your wrists.
- Strengthening and stretching: Regular exercises for wrist and hand mobility can help prevent strain on the tendons.
Summary:
De Quervain’s tenosynovitis is an inflammation of the tendons on the thumb side of the wrist, often caused by overuse or repetitive motions. Symptoms include pain, swelling, tenderness, and limited thumb movement. Treatment includes rest, splinting, anti-inflammatory medications, and in some cases, corticosteroid injections or surgery. With proper care and adjustments, most people recover well from De Quervain’s tenosynovitis.