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DE QUERVAIN Tendinitis


De Quervain's tendinitis occurs when the tendons around the base of the thumb are irritated or constricted. The word "tendinitis" refers to a swelling of the tendons. Thickening of the tendons can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping things, or when turning the wrist.

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Tendinitis may be caused by overuse. It can be seen in association with pregnancy. It may be found in inflammatory arthritis, such as rheumatoid disease. De Quervain's tendinitis is usually most common in middle-aged women.

Signs of De Quervain's tendinitis:
  • Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
  • Swelling may be seen over the thumb side of the wrist. This swelling may occur together with a fluid-filled cyst in this region.
  • A "catching" or "snapping" sensation may be felt when moving the thumb.
  • Pain and swelling may make it difficult to move the thumb and wrist.
  • Numbness may be experienced on the back of the thumb and index finger. This is caused as the nerve lying on top of the tendon sheath is irritated.
The Finkelstein test is conducted by making a fist with the fingers closed over the thumb and the wrist is bent toward the little finger. Tenderness directly over the tendons on the thumb side of the wrist is a common finding with this test.

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Treatment
The goal in treating de Quervain's tendinitis is to relieve the pain caused by irritation and swelling.

Nonsurgical Treatment
  • Splints. Splints may be used to rest the thumb and wrist.
  • Anti-inflammatory medication (NSAIDs). These medications can be taken by mouth or injected into that tendon compartment. They may help reduce the swelling and relieve the pain.
  • Avoiding activities that cause pain and swelling. This may allow the symptoms to go away on their own.
  • Corticosteroids. Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.
Surgical Treatment
Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the compartment (covering) to make more room for the irritated tendons. The surgery is an outpatient procedure and is usually done under local anesthesia. Surgical release of the tight sheath eliminates the friction that worsens the inflammation, thus restoring the tendons’ smooth gliding capability.During surgery, additional procedures may be conducted to remove inflamed tissues or small cysts.

Recovery times vary, depending on your age, general health, and how long the symptoms have been present. Light use of the thumb is possible immediately with a progressive return of range of motion and strength over the next few weeks. Normal use of the hand usually can be resumed once comfort and strength have returned. 
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