De Quervain's disease [symptoms, treatment and diagnosis]

What is de Quervain's disease?

This pathology is characterized by the appearance of an inflammatory process and a narrowing of the sheath covering the connective tissue part of the two muscles. We are talking about the extensor pollicis and the long muscle responsible for its abduction. The disease was named after the famous Swiss doctor Fritz de Quervain, who studied it at the end of the last century.

De Quervain's disease occurs against a background of prolonged tension in the muscles of the hand and thumb, as well as as a result of severe trauma to the hand. In addition, the anatomy of the sheath surrounding the tendons in each individual patient plays a significant role (the presence of additional fibrous formations, the presence of narrow branches, etc.). Often, de Quervain's disease and the symptoms of this disease appear in people engaged in certain professional activities (copywriters, programmers, pianists, etc.).

If we talk about the most common signs of the disease, they include pain and local swelling. As a rule, this pathological process is characterized by a slow course. Acute symptoms are possible in case of injury to the hand. At the initial stage, the patient notices episodic pain that appears during abduction of the thumb or when the wrist suddenly rotates towards the fifth finger.

Increased pain in de Quervain's disease is not immediately observed. However, over time, even minor motor activity of the hand will begin to cause significant discomfort to the patient. In some situations, the pain syndrome spreads to the shoulder or nail plate. Swelling may also appear in the tendon canal area. In advanced cases, the pain becomes intense, which prevents normal movement of the finger.

Symptoms of de Quervain's tenosynovitis

De Quervain's tenosynovitis can cause various symptoms, such as:

pain in the wrist area under the base of the thumb; When you move your thumb, the pain may intensify;
wrist pain that spreads to the forearm and thumb;
mild swelling, redness, or warmth in the wrist;
a fluid-filled cyst on the wrist near the thumb.

Your doctor can determine whether you have de Quervain's tenosynovitis based on your symptoms and the results of a physical examination. You may also be asked to make certain movements with your hand, wrist, and thumb.

In most cases, people do not need to have an x-ray, but your doctor will tell you if you need one.

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What categories of patients are at risk?

Often the above pathology is called stenosing tenosynovitis or “mother’s wrist.” At the same time, the most susceptible persons to the disease include patients who perform the same type of hand movements for a long period of time (pushing, grabbing, using a keyboard or mouse for a computer).

Moreover, sewing, knitting or playing the piano can cause de Quervain's disease and impair the functions of the thumb. Work associated with the frequent use of construction tools can also provoke the disease. Quite often, de Quervain's disease and impaired movement in the hand manifests itself as a result of injury to the wrist area or against the background of an inflammatory disease of the joints. As for the name “mother’s wrist,” its origin is often associated with women’s prolonged carrying of babies in their arms or with their performance of household duties.

Causes of de Quervain's tenosynovitis

Some causes of de Quervain's tenosynovitis are listed below.

Wrist strain due to repetitive movements, such as: typing on the keyboard a lot;
when you knit a lot;
when you use a hammer;
when you hold your baby for a long time;
when you are carrying heavy bags of groceries.

Sprain or injury to the wrist area.

Conditions that cause swelling of the entire body, such as rheumatoid arthritis.

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Diagnosis of de Queven's disease

An obligatory stage of diagnosis is examination of the hands, which makes it possible to identify disorders characteristic of the affected area. It should be noted that there is no increase in temperature or other changes in the skin around the diseased area. However, certain methods are known that make it possible to clearly establish stenosing ligamentitis in a patient:

Finkelstein test. It is used to detect this disease if the patient has pain in the area of the wrist joint. During the diagnosis, a person is asked to press the first finger into the palm, then connect it with other fingers, and finally bend the hand in the direction of the fifth finger. At the same time, during physical activity the patient notices sharp discomfort in the affected area. In addition, the above ailment can lead to loss of the ability to hold objects with the thumb. You can check this point if you give the patient several things at once (for example, a box of matches and pens): if he has the disease, he will not be able to hold objects with his first and second fingers;
may be needed to confirm the diagnosis of de Quervain's disease . On the resulting images, you can notice the presence of calcification in the area of the first osteofibrous canal;
MRI. Using this method, it is possible to exclude the presence of any other disease.

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Hand Surgery Clinic

De Quervain's disease (tenosynovitis, stenosing ligamentitis, stenosing tenosynovitis)

is a disease of the hand, manifested by sharp pain in the wrist area during physical activity (for example, when you pick up a child, lift a mug or a kettle).

The disease occurs when the canal in the area of the wrist joint is narrowed, in which the tendons that extend and abduct the thumb are located. Because of this, the friction of the tendons increases, causing local inflammation, leading to severe pain. Typically, the cause of de Quervain's disease is overuse of the hand. As a rule, the disease develops gradually, but causes a lot of inconvenience in everyday life.

Typical signs of de Quervain's tenosynovitis:

Pain and swelling along the outer surface of the wrist joint with transition to the base of the thumb (along the tendons)
A sharp increase in pain when putting pressure on the hand
Decreased hand strength

Diagnostic test:

Finkelstein's symptom: if you clench your thumb into a fist and move your hand towards the little finger, a sharp pain occurs along the tendons on the back of the first finger.

Treatment of de Quervain's disease:

Treatment should begin with conservative methods. It is recommended to exclude painful loads, use anti-inflammatory ointments, physiotherapy and fixation of 1 finger with a cut. If the pain persists or intensifies within 10 days, it is recommended to perform a blockade with hormonal anti-inflammatory drugs or decide on surgery.

If 1-2 blockades are ineffective, surgical treatment is indicated - an operation to dissect the narrowed canal of the extensor muscles of 1 finger. This intervention is performed under local anesthesia. It can be performed openly (from a small skin incision) or minimally invasively, through several punctures of the skin with a needle.

What is needed for treatment in one visit?

In our center, it is possible to treat de Quervain's disease in one day (minimally invasive surgery). To do this, you just need to send photos of your hands by email or whatsapp (8), describe your complaints and answer questions. Our specialists will study the information received and draw up an individual treatment plan. Please note: to select the surgical technique, ultrasound results of the first extensor canal are required.

When performing open surgery, an examination is required the day after surgery.

To carry out the operation, you must have with you the following tests: general blood and urine test (valid for 10 days), biochemical blood test - glucose, uric acid, CRP, rheumatoid factor (valid for 10 days), risk factors - test for hepatitis B, C, RW , HIV (valid for 3 months).

It is advisable to indicate in the letter:

Full name and year of birth
Contact phone number and city of residence
The area of pain and how long ago the pain began there
Did the pain begin to develop gradually, or after an injury?
Do you experience clicking or snapping of your finger or fingers when bending and straightening?
Do your fingers go numb (do you wake up with the feeling that your hand has been resting?)
Did your hand problems appear after an injury?
Have you been operated on before? If so, where and when (it is advisable to send a copy of the discharge summary after the operation, and mark the postoperative scar on the photo of the hand with a marker)
Attach a photo of your hand (top and side view), preferably using a marker or pen to indicate problem areas on the hand
Do you have chronic diseases - rheumatoid polyarthritis, gout, diabetes mellitus, etc.

Describe the problem in any form: what bothers you and for how long, who you turned to for help, what treatment you received (was there an effect), what studies were performed (you must attach copies of medical documents if available).

You can also simply make an appointment by phone for a consultation, where we will make an accurate diagnosis, draw up an examination and treatment plan, and also set a date for surgery (if necessary).

Treatment of de Quervain's disease

If the patient is diagnosed with de Quervain's disease, treatment begins with conservative methods:

Reducing loads;
Recommendations related to the use of ointments that have an anti-inflammatory effect;
Using a special splint to fix the first finger.

In some cases, steroid medications may be needed to be injected into the tendon area.

If de Quervain's disease is diagnosed, and treatment with ointments does not give the expected result within 2 weeks, move on to another method of eliminating the disease. Moreover, experts are inclined to use hormonal agents with an anti-inflammatory effect. In the most acute situations, surgical intervention is performed.

When choosing a tactic, the following points are taken into account: the presence of chronic pathologies and characteristic symptoms.

If we talk about the practical side and experience of employees, then the necessary positive effect can only be obtained with timely conservative treatment. The key goal of this method is to relieve the inflammatory process, eliminate pain, strengthen muscles and ligaments, and also prevent further development of the disease.

Also, the priority method is to use an injection. For severe pain and significant inflammation, corticosteroids are prescribed. However, the consequences of using such drugs are often negative. In general, over 90% of patients report positive dynamics when using medications.

Reducing the load on the hand in de Quervain's disease

By observing the ergonomic regime, it is possible to minimize the load on the hand. To achieve this result, you should avoid repetitive movements. It is also necessary to reduce the period of monotonous activities. It is advisable to reduce the time spent at the PC and performing sports training. In addition, prolonged use of a smartphone should be avoided. The upper limb should be in a calm state more often.

Physiotherapy for de Quervain's disease

Physiotherapeutic methods are aimed at relieving pain and eliminating inflammation. However, in the presence of tachycardia, elevated temperature, malfunctions in the circulatory system and oncological processes, such procedures are prohibited.

Particularly effective for patients who have been diagnosed with de Quervain's disease and the symptoms of this pathology are: exposure to shock waves, laser therapy, cold treatment, and the use of a static magnetic field.

Only an experienced physiotherapist can choose the right way to perform the procedure. To achieve the best results after using physiotherapeutic methods, it is better to perform them in the initial stages of the disease. Also, do not underestimate the procedures of phonophoresis and electrophoresis, which allow you to quickly stop inflammation and cope with the adhesive process.

Often the active development of pathology is associated with the presence of rheumatoid arthritis. In such situations, if the patient is confirmed to have de Quervain's disease, treatment in Moscow will include the following measures:

Exposure to a static magnetic field;
Introduction of active substances into the deep layers of the skin under the influence of high-frequency ultrasound;
Ural Federal District;
Application of paraffin-ozokerite application;
UVT.

Treatment of de Quervain's disease using shock wave therapy

When the affected area is exposed to shock waves, adhesions can be quickly eliminated, while healthy tissue remains intact. It also ensures activation of the immune system, relieves symptoms of inflammation, forms new blood vessels, improves metabolic and recovery processes, and normalizes blood flow.

As a rule, a full course of shock wave therapy includes several procedures, with a break of 6-7 days. Patients begin to feel relief after the first two sessions. The intensity of pain decreases and swelling goes away.

After completing the final procedure, movements in the hand area are restored. However, the key goal of such therapy is to completely normalize the functioning of the tendon apparatus and eliminate the consequences of narrowing of the canal.

For the effective implementation of the shock wave method, hospitalization of the patient is not required. The procedure is performed on an outpatient basis. After the patient is comfortably positioned on the couch, the specialist applies a gel-like substance to the affected area, which enhances the effect of shock waves. Also during UVT a special sensor is used.

The duration of one procedure does not exceed 20 minutes. However, some patients may experience slight tingling followed by redness of the skin, which occurs several hours after completion of the session.

Orthotics and taping

One of the mandatory stages in eliminating the disease is orthotics, which involves the use of special devices that allow you to fix the hand and fingers in the correct position. The duration of immobilization can reach 35-40 days, depending on the speed of pain relief.

This technique is indispensable for patients who have restrictions on the use of corticosteroid hormones.

Experienced physiotherapists will work with you at the hospital and help you choose the most effective way to eliminate discomfort and cope with other undesirable manifestations of the disease.

Surgical intervention

If conservative methods do not produce a noticeable effect, you should seek the help of a surgeon. The surgery is performed in a hospital using local anesthetics. After completing the manipulation, a scarf-type bandage is applied to the arm. Sutures are removed after 9-10 days, and restoration of the upper limb’s functionality is observed 14 days after the intervention. During the rehabilitation period, some patients note the appearance of goosebumps and loss of sensation in the area of the first three fingers of the hand. These manifestations disappear 14-20 days after surgical manipulation.

In our clinic, surgical intervention is performed under the guidance of experienced specialists. However, the highest priority activity is the implementation of the UHT procedure. In this case, European quality equipment is used, and a 20% discount is provided for the first consultation.

Postoperative treatment

After the operation, the patient returns home, his fingers and especially the thumb and wrist should remain in motion, but not overworked.
5-7th day after surgery: first change of bandage (can be performed by a family doctor).
14th day after surgery: change of bandage and removal of stitches (can be performed by a family doctor).
One day after the stitches are removed, the bandage is no longer needed. Start regular (3-4 times a day) exercises in cold water (add ice if necessary). Cold relieves swelling and pain. Patients who cannot tolerate cold take warm water.
Five days after the sutures are removed, treatment of the postoperative scar begins. Calendula ointment (or other fatty ointments) is rubbed into the scar 4-5 times a day, it softens, becomes elastic, less painful and sensitive. Patting the scar, for example with a soft brush, also helps.
Therapeutic exercises and/or occupational therapy are rarely required, but are prescribed immediately if movement difficulties occur.
The duration of the patient's disability is usually 2-3 weeks.

Recovery prognosis

As a rule, with timely and competent treatment, specialists guarantee positive dynamics. If conservative procedures are implemented, it is possible to count on a favorable prognosis in 50% of situations. After surgery, it is possible to achieve the maximum positive effect. However, if after surgical manipulation the patient continues to overload the hand, a relapse of the disease may occur. This indicates the need to change the nature of the patient’s work activity after completion of treatment.