De Quevain’s Tenosynovitis

De Quevain’s Tenosynovitis
May 23, 2016

hqdefault“When swelling in the tendons at the base of the thumb exerts pressure on the nearby nerves and causes pain and numbness in the thumb towards the wrist end reaching up to the forearm, it is referred to as De Quervain’s Tenosynovitis”, ponders Dr. Gupta while speaking about the condition. “See, there are two tendons at the base of the thumb which are covered by a soft layer which makes it easy for them to run through the sheath. With pressure or stress the tendons sometimes get damaged and cause loss of motion”, he exerts.

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At present an integral part of Max Healthcare, Dr. Gupta eminently puts forth his conceptions concerning De Quervain’s Tenosynovitis, “Any pain at the base of the thumb with a kind of bulge formation should be immediately consulted as leaving it untreated can cause permanent loss of motion in the thumb and tendon sheath to burst.”
An MBBS and MS Ortho from AIIMS, Dr. Gupta has completed his higher analysis in hand and upper extremity from Germany and USA.

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“There are no imaging tests required to ascertain the condition rather can be concluded with a simple test called Finkelstein test”, says Dr. Gupta with emphasis that, “ pregnant women and more so middle aged should be alert as they are the most susceptible group besides those that have repeated use of the thumb.”
Though more than 6000 surgeries and 20 years of experience makes him adept at handling complex cases he still treats all his cases with a diligent and passionate approach, “I have treated many patients with De Quervain’s with both conservative techniques and by surgery and in general have observed that though non surgical techniques are effective in mild pain, a cut in the tendon sheath is the best treatment for severe damage. The patient should take extreme precaution to curtail activities that involve repeated overuse of thumb and keep on with exercises to provide relief to the tendons.”

 

FAQ – De Quervain’s Tenosynovitis

There are two tendons at the base of the thumb that connects it to the wrist. Tendons are structures which act as connectors between muscles and bones and are covered by a slippery, soft, thin layer called synovium which enables the tendons to slide easily through a fibrous tunnel. When these tendons swell and rub against the narrow covering through which they run, a painful and enervating condition occurs which is termed as De Quervain’s Tenosynovitis.
Repeated overuse of the wrist, Rheumatoid Arthritis, any direct injury to the wrist resulting in tendon impairment, pregnancy or middle age are some of the causes that are associated with this condition.
The main symptom is an intense pain on the thumb side of the wrist which is aggravated while grasping or pinching. Swelling is another common sign accompanied usually with a snapping sensation while moving the thumb. A cyst which is fluid filled and appears like a possible bulge at the base of the thumb or numbness along the back of the thumb and index finger are other significant signs that indicate De Quervain’s Tenosynovitis.
Middle aged women or women just after pregnancy are 10 times more susceptible to this condition than others.
De Quervain’s Tenosynovitis is diagnosed by Finkelstein test. Under this test the patient is asked to place his thumb against the hand and then make a fist with the thumb enclosed. The patient is then asked to bend the wrist toward the little finger. The test is considered positive if there is immense pain during this test.
The treatment is sought to provide relief from the intense pain and stop further deterioration of the tendons.
Non Surgical Treatment Techniques: comprising of oral anti inflammatory medicines and corticosteroid injections inserted in the tendon sheath, the thumb and wrist are put in a splint or brace to provide rest to reduce the swelling and pain. The patient is also recommended to go in for mild therapy exercises and avoid activities that cause the pain to aggravate.
Surgical Technique: When conservative techniques fail to provide relief or the condition is severe then the patient might have to undergo surgery in which the surgeon makes a small cut in the tendon sheath to enable them to move freely thereby reducing friction and pain. Therapy exercises are recommended after surgery too.
The only way it can be prevented is by avoiding repetitive movements and if mild pain is felt then the wrist and thumb should be given rest or immobilized to curb the impending condition.
No, it needs to be aptly treated else it might permanently limit movement of the thumb or the tendon sheath might just burst open.
Posted in Condition & Treatments by admin