What is DeQuervain Tendinitis?
DeQuervain tendinitis is a condition caused by the compression of two thumb tendons in the 1st dorsal compartment of the hand (Extensor Pollicis Brevis and Abductor Pollicis Longus) at the wrist level, usually within a tunnel-like structure or sometimes within a sheath.
This disease is named after the Swiss surgeon Fritz de Quervain (1868-1940).
When these tendons become trapped within the sheath or tunnel at the base of the thumb, inflammation occurs, causing the tendons to swell and enlarge. Pain is usually experienced during thumb and wrist movements. Making a fist, gripping an object, or holding onto something are commonly reported painful activities.
What Causes DeQuervain Tendinitis?
The cause of DeQuervain tendinitis is usually inflammation in the relevant thumb tendons at the wrist level, resulting from repetitive movements. A common example is seen in new mothers. Carefully holding a newborn baby can cause the mother to place her wrist in a poor position. In addition, hormonal fluctuations during pregnancy and postpartum, and the poor wrist position while breastfeeding, can contribute to the condition. Wrist fractures can also cause DeQuervain disease due to increased stress on the tendons.
What are the Symptoms of DeQuervain Tendinitis?
The most significant symptom of DeQuervain tendinitis is pain on the thumb side of the wrist. The pain can develop gradually or have a sudden onset. The pain occurs at the wrist level in the 1st dorsal compartment and can radiate to the thumb or forearm. Pain increases during challenging gripping and twisting, hand, and thumb movements. Swelling in this area may indicate the presence of a fluid-filled cyst (cystic hygroma). Patients may sometimes experience sensations of catching and snapping. Pain and swelling can make it difficult to form a fist. Numbness in the thumb and index finger can sometimes accompany DeQuervain disease, as the nerve providing sensation to the dorsum of these two fingers has a close proximity in this area. Inflammation in this area can also affect the neighboring nerve.
How is DeQuervain Tendinitis Diagnosed?
During a physical examination, the patient is asked to fold the thumb into the palm and cover it with the other four fingers, forming a fist. Then, the wrist is bent towards the little finger side. Pain in this area occurs in those with DeQuervain disease (Finkelstein test).
What is the Treatment for DeQuervain Tendinitis? The Role of Cortisone Injections in DeQuervain Tendinitis Treatment
The goal of treatment is to alleviate pain caused by irritation and swelling. You can use pain relievers after consulting with your doctor.
Applying ice, especially during the initial days of pain, is among the first-line treatments.
Cortisone Injection under Ultrasound Guidance for DeQuervain Tendinitis Treatment
Injecting cortisone into the compressed tendon compartment is another treatment option. Using ultrasound imaging, the tendons are visualized, and cortisone is injected into the tendon sheath. This is a highly successful procedure. However, the duration of its effectiveness varies from patient to patient.
When is Surgery Necessary for DeQuervain Tendinitis?
If the severity of symptoms is high and non-surgical treatments do not provide relief, surgery is planned as soon as possible.
How is DeQuervain Surgery Performed?
The surgery is performed under regional or general anesthesia, with a tourniquet used to temporarily stop blood flow for better visualization of the surgical area. The nerve that provides sensation to the thumb runs beside the compressed tendons. Protecting this nerve during surgery is important. The goal of the surgery is to open the compartment of the compressed tendons, providing more space for the tendons and eliminating inflammation.
