DE QUERVAIN DISEASE
De Quervain
disease is a stenosing tenosynovitis of the abductor pollicis longus and the
extensor pollicis brevis tendons at the styloid process of the radius. It is
most common in women between 30 and 50 years of age. The cause remains
uncertain but may be related to friction between the tendons, their fibrous
sheath, and the underlying bony groove caused by movement of the thumb and
wrist. The resulting inflammation causes thickening and stenosis of the
synovial sheath of the first compartment of the extensor retinaculum (dorsal
carpal ligament).
CLINICAL
MANIFESTATIONS
Pain
develops over the styloid process of the radius, radiating up the forearm and
down the thumb. Occasionally, the pain occurs suddenly after a strain of the
wrist. The aching pain, aggravated by use of the hand, gradually intensifies
and may sometimes cause considerable weakness and disability.
Examination
shows a sharp tenderness over the styloid process of the radius, and a visible
swelling and palpable thickening of the fibrous sheath may be detected. Sharp
pain at this site is often produced by active extension and abduction of the
thumb against resistance. The Finkelstein test usually causes severe pain.
TREATMENT
Often,
symptoms are relieved by injecting a corticosteroid into the sheath or placing
the forearm, wrist, and thumb in a cast or removable splint for about 1 month,
or both. If the pain recurs and persists after this treatment, surgery is
indicated. With the use of local anesthesia, a short transverse incision is
made over the sheath on the lateral aspect of the wrist; care must be taken to avoid the
sensory branches of the superficial branch of the radial nerve. The thickened
sheath is opened with a longitudinal incision through the first compartment,
freeing the involved tendons. Great care must be exercised to locate and free
all the tendons in the compartment because aberrant tendons and anatomic
variations in the tendons and sheaths are common in this area. The incision is
then closed. Prognosis is excellent.
