De Quervain syndrome, an overview of stenosing tenosynovitis

By Cristiano Antonino On Jun 14, 2023

De Quervain syndrome – also known as stenosing tenosynovitis – is an inflammatory process affecting the synovial sheath of the extensor brevis and abductor pollicis longus tendons

The disease is characterized by narrowing of the synovium where the tendons pass over the radial styloid, a bony protrusion

The inflammatory process causes an increase in the volume of the digital canal, consequently a friction is created during the sliding of the tendons which is very painful.

De Quervain’s syndrome mainly affects patients who practice certain professional activities, such as video terminal workers or embroiderers.

The main cause of the pathology, in fact, lies in repeated microtraumas, linked to repeated gestures.

The most common symptom of the disease is intense pain that the patient feels when making a gripping movement involving the thumb or tilting the wrist.

The pain may be accompanied by other signs such as swelling of the area and swelling.

If left untreated, the pathology can evolve leading to the development of tendinosis, caused by the progressive wear and tear of the tendons.

De Quervain syndrome: what is it?

De Quervain syndrome is more commonly referred to as stenosing tenosynovitis.

It is a pathology that affects the tendons of the hand which are essential for the flexion of the fingers.

Tendons connect the forearm muscles with the finger bones, functioning like ropes.

In the fingers there are pulleys, fibrous tunnels inside which the tendons are found.

Their presence and sliding are favored by the tendon sheaths.

Pulleys hold the tendons close to the bones to aid in the flexion motion of the fingers.

De Quervain syndrome occurs when a swelling develops in the tendon sheath

This has consequences: every time the tendon crosses the pulley at the bulge it is squeezed. The result is severe pain and a snapping sensation in the finger.

When the tendon snaps, it produces inflammation and swelling, creating a sort of vicious circle that does not allow the inflammation to stop.

In some patients, the finger may lock in flexion, making it very difficult and painful to straighten it.

Causes

The causes of De Quervain syndrome have not yet been clear and, to date, are not certain.

According to some studies, however, there are some factors that influence the onset of the disease.

The first element to consider is repeated activities.

A continuous solicitation of the tendons of the hand, due to repeated movements and efforts, can cause inflammation of the flexor tendons.

Among the people most affected by the disease, not surprisingly, there are the professional categories that continuously use some tools, such as screwdrivers or scissors.

Another frequent habit that can contribute to the onset of the disease is the use of the cell phone.

De Quervain syndrome is closely linked to other pathologies such as gout, rhizarthrosis, diabetes and rheumatoid arthritis, which can accompany or cause stenosing tenosynovitis.

In very rare cases the disease can be congenital, while in the majority of cases the threshold of 40 years is exceeded, especially in women.

In fact, with aging, our body loses its natural ability to synthesize collagen, one of the substances that make up soft tissues.

As a result, the tendons weaken and are more prone to inflammatory diseases. Another aspect not to be ignored are hand injuries.

A small accident during sport or a fall from a bike can cause microtraumas and, consequently, tenosynovitis.

De Quervain syndrome affects the flexor brevis and abductor pollicis longus tendons

Usually the disturbance occurs mainly in the morning and subsides during the day.

The symptoms are obvious. The patient experiences swelling, tingling and warmth in the hand, accompanied by difficulty in movement and intense pain in the palm.

Often there are also subcutaneous nodules between the metacarpal and phalanges, in correspondence with the joint.

Other signs are a clicking or crackling sensation during movement of the hand muscles (flexion and extension), especially when trying to grasp an object or making a fist.

In the most serious cases the impossibility of extending the affected fingers is recorded, which remain bent, in others the fingers remain in a flexed or extended position.

Diagnosis

The diagnosis of De Quervain syndrome is clinical.

The area affected by the inflammation, in fact, appears as painful to pressure and swollen.

For a correct diagnosis it may be useful to carry out the Finkelstein test which allows you to record the level of pain that is felt by the patient.

During the examination, the subject is asked to make a fist, locking the long fingers around the thumb and flexing the wrist towards the little finger.

In fact, in patients with De Quervain syndrome, thumb movements are difficult due to the presence of intense pain, which is exacerbated when the wrist is tilted.

Subsequently, the ultrasound will allow to highlight with greater precision the presence of inflammatory alterations of the tendons and of the walls of the synovial sheath.

How is De Quervain Syndrome treated?

If the pathology is in its initial phase, conservative treatment may prove effective, with the intake of anti-inflammatory drugs and functional rest.

This treatment can help reduce inflammation and symptoms.

Applying ice to the radius styloid process may help reduce pain.

In the most serious cases, the doctor can also prescribe corticosteroid drugs which are administered by infiltration.

Local therapy is useful for the most acute forms, but also presents risks (such as tendon rupture) related to cortisone infiltration.

Furthermore, it does not ensure complete resolution of the disease, guaranteeing results that are temporary.

When conventional therapies do not help reduce the symptoms, it is necessary to resort to surgical treatment (puleggiotomy).

The operation consists in opening the sheath to favor the sliding of the tendons in a correct way.

It is a solution-type operation that guarantees immediate effects.

In fact, recovery is optimal and occurs as early as three or four days after surgery, with an excellent prognosis.

In any case, if De Quervain’s syndrome is not treated adequately and is neglected, it can evolve and become chronic, giving rise to rizoarthrosis, i.e. a form of arthrosis of the base of the thumb.

De Quervain syndrome: surgical treatment

The surgery allows you to cure De Quervain syndrome and is performed under local anesthesia.

The surgeon makes an incision in the palm of the hand and proceeds to section and open the pulley located at the base of the finger.

The goal is to increase the space to allow for sliding of the tendon.

The surgical operation takes about ten minutes and about an hour after the operation the patient can go home.

After seven days, he will return to the hospital to carry out the first dressing, while after fifteen days it will be possible to remove the stitches.

Following the pulleggiotomy it will be mandatory to observe a period of rest.

In these weeks the patient will be able to move his hand, but he will have to avoid efforts, traumas in the area of the operation and demanding manual work.

Furthermore, from the day following the operation, it is advisable to move and extend the finger to prevent stiffness from arising.

The surgery has some complications, but they are quite rare.

Among these we find the rupture of the tendon and the “bowstring” effect, stiffness of the finger (caused by the choice not to move it in the post-operative period), minor infections, treatable with antibiotics or recurrences.

The improvement, in the majority of subjects, is evident from the following day, while complete recovery occurs in about three months.