DE QUERVAIN TENOSYNOVITIS                                     KANDIL NOTES

INTRODUCTION

  • De Quervain Tenosynovitis is an inflammatory condition of the wrist where two of the tendons responsible for thumb motion (APL and EPB) become inflamed under their sheath 

  • It affects women more often than men. Commonly affects new mothers and grandmother

  • CAUSES

  • The exact pathophysiology is unknown although repetitive activities like lifting and carrying small objects may increase the risk

  • Contributing factors include genetic changes, workplace factors, and medical conditions such as pregnancy, postpartum period, and lactation

  • SIGNS AND SYMPTOMS

  • De Quervain Tenosynovitis is characterized by pain in the area of the wrist closer to the thumb and back of the hand

  • The involved area is often very sensitive to touch and wrist/thumb motion as well as carrying objects may exacerbate the symptoms

  • A tender nodule can be felt at the level of inflammation in the wrist

  • TREATMENT​​

  • De Quervain Tenosynovitis usually improves without surgery 

  • The first line of treatment involves a type of brace called a thumb spica brace that can be helpful by immobilizing the wrist and thumb, thereby decreasing inflammation and pain

  • A home exercise or supervised therapy program can also help improve symptoms

  • Anti-inflammatories such as ibuprofen are oftentimes helpful as an adjunct to other treatments

  • De Quervain Tenosynovitis steroid injections have an excellent track record in decreasing symptoms and treating the condition

  • Surgery is reserved for cases that don’t improve after a course of conservative management if symptoms are significantly affecting activities of daily living and quality of life. Surgery is composed of a small incision in the wrist and release of the affected sheath overlying the APL and EPB tendons. This is minimally invasive and is done under local anesthesia and mild sedation. Recurrence is rare after open release

        PREVENTION

  • The best way to prevent this condition is to be mindful and cognizant of your thumb position when carrying objects

  • It is important to avoid over-straining or stretching your thumb constantly and repetitively when carrying things

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