De Quervain

1. De Quervain’s Disease About De Quervain Disease De Quervain's disease, sometimes referred to as mother's thumb or gamer's thumb, is a common wrist pathology. De Quervain's disease is thought to be caused by thickening of the synovial sheath containing the tendons of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL), which causes irritation of the muscles and causes pain and swelling over the radial side of the wrist in patients along with increased difficulty gripping objects. The exact mechanism underlying this condition is unknown. The disorder known as "De Quervain tenosynovitis," after Swiss surgeon Fritz de Quervain, is characterised by tendon entrapment that affects the wrist's first dorsal compartment. De Quervain disease Causes De Quervain disease causes have been linked to myxoid degeneration with fibrous tissue deposits and enhanced vascularity rather than acute inflammation of the synovial membrane, while the precise origin of the condition is unknown. The abductor pollicis longus and extensor pollicis brevis tendons become painfully ensnared in the thickened tendon sheath caused by this deposition. It is linked to repetitive wrist motions, particularly those involving simultaneous extension, radial wrist deviation, and thumb radial abduction. Mothers of newborns who frequently lift their babies as their wrists shift from ulnar to radial deviation and their thumbs are considered the classic patient population. Epidemiology - According to one study, the peak prevalence of de Quervain tenosynovitis occurs in people in their forties and fifties, accounting for 0.5% of cases in males and 1.3% in women. People having a history of medial or lateral epicondylitis may be more susceptible to the illness. There are two major risk factors for the disease: being pregnant and working physically. Clinical Anatomy of Disease Both the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon are impacted by De Quervain's syndrome. These muscles originate from the dorsal aspect of the forearm and extend to the lateral side of the thumb via an extensor retinaculum and processus styloideus radii fibrous-osseous tunnel.

2. Source: https://harleyclinic.com/treatments/hand-and-upper-limb/de-quervain- syndrome/ The increased stress over the tendon sheaths causes fibrocartilage to develop, which thickens the tendon. The tendon sheaths are covered in neovascularization. In this syndrome, the tendons also exhibit myxoid degeneration. De Quervain Disease Symptoms Patients present with radial-sided wrist pain typically worsened by thumb and wrist motion. The condition may be associated with pain or difficulty opening a jar lid. Tenderness overlying the radial styloid is usually present. If present, the swelling over the wrist is generally seen proximal to the radial styloid. The typical patient population is a pregnant woman in the third trimester or a breastfeeding mother who holds her child repeatedly.

3. De Quervain Disease Diagnosis De Quervain tenosynovitis is diagnosed clinically from the typical history and physical examination findings. Plain radiographs can help rule out other possible causes of radial wrist discomfort, such as thumb carpometacarpal joint osteoarthritis, but they cannot be used to confirm the diagnosis. Different clinical tests that are provocative have been described for de Quervain tenosynovitis. The patient must place their thumb in palmar flexion for the Finkelstein test while the examiner performs ulnar deviation of the wrist. Sharp discomfort that is felt at the first dorsal compartment along the radial wrist indicates a positive test. In order to perform the Eichhoff test, the patient must grip their thumb with their other fingers while bending their wrist in the direction of the ulna. If the test is positive, this will cause a severe shooting pain over the radial aspect of the wrist. Another provocative clinical test documented for this illness is the WHAT test, which causes wrist hyperflexion and thumb abduction. The following differential diagnoses can resemble this condition: first carpometacarpal joint osteoarthritis fracture of the scapula styloid fracture radially Radial nerve neuritis in the sensory branch (Wartenberg's syndrome) Syndrome of intersections Thumb trigger Treatment/ Management of De Quervain’s disease De Quervain tenosynovitis has the potential to resolve on its own and may not require medical attention. The most common nonsurgical treatment options for patients with ongoing symptoms are corticosteroid injections, systemic anti- inflammatories, and splinting. One or two corticosteroid injections have been shown to offer almost total relief in 52% to 90% of individuals. Acupuncture, therapeutic ultrasound therapy, and laser therapy are a few more nonoperative treatment techniques that have been reported; nevertheless, there is neither a consensus nor good data on these therapies' efficacy. An operation may be necessary if corticosteroid injections do not relieve symptoms or if they return. Conclusion For De Quervain's tenosynovitis to be effectively managed, the patient will need to follow a highly personalized, impairment-driven treatment plan. Early splinting during the acute phase will help the patient avoid aggravating the tissues and enable them to carry out tasks necessary for work and self-care. The patient must be informed about the timelines for tissue repair as well as the significance of avoiding activities that exacerbate their symptoms. Exercise therapy progresses from isometric to eccentric to concentric inner range exercises. A patient should be pain-free prior to advancing to the subsequent strengthening phase.