De Quervain's Tendonitis
De Quervain’s tendonitis is an unpleasant burning of the gristles at the root of the thumb. This malfunction involves the gristles of the short extensor and the long muscle comes in the role of an abductor. These muscles are situated in the anatomical tunnels of the forearm and pass to the lateral side of the thumb through the fibrous-bone tunnel formed by the styloid cause of the ulna and the retinaculum.
De Quervain’s tendonitis can be caused by overuse. It also frequently appears during the course of pregnancy and rheumatoid arthritis. Middle-aged females are at high risk of getting de Quervain’s disease. New moms usually suffer from bilateral damage as the medical practice shows.
The main complaint of patients is pain in the wrist, which is felt in the forearm when trying to grab something with the thumb or straighten it. The pain is described as “constantly aching, burning, twitching.” Often, it is aggravated by grasping, squeezing, or twisting movements. Examination may reveal edema in the area of the anatomical snuffbox, sensitivity in the area of the styloid process of the radius, reduced range of motion in the first metacarpal-carpal joint, palpable thickening of the anatomical tunnels in the back, tendon crepitus. Other manifestations include weakness and paresthesia of the hand.
Nonsurgical Treatment of De Quervain's Tendonitis
Treatment of de Quervain’s disease can be conservative or can be carried out by surgery. Traditional treatment includes such methods as:
- Immobilization of the affected ligament with the imposition of a plaster cast;
- Physiotherapy procedures (warming up with paraffin, ozokerite);
- The use of non-steroidal anti-inflammatory drugs, novocaine anesthesia;
- Hydrocortisone injections.
Ultrasound examination, according to some estimates, can have a positive effect on treatment results. In addition, it can act as a diagnostic tool in de Quervain’s tendonitis. The ultrasound-guided injections were more effective with de Quervain’s tendonitis and there were no side effects. Ultrasound-guided injections into the extensor muscle of the thumb with septation are more effective than manual injection.
Surgical Treatment of De Quervain's Tendonitis
Surgical treatment of de Quervain’s tendonitis is usually carried out under anesthesia and involves excision of the ligament canal in order to decompress the tendons. Operations are used in case of insufficient effectiveness of conservative treatment. During the operation, the surgeon removes the inflamed tissue and cuts the fused tendons. Usually, two weeks after the operation, the patient is removed the stitches and prescribed a course of rehabilitation exercises (exercise therapy of the thumb and wrist joint).
In order for a doctor to establish a correct diagnosis, the patient has to pass the following tests:
- Radiography (in the case of de Quervain’s tendonitis, calcification is observed in the area of the first fibrous canal on the radiograph of the wrist joint in frontal projection);
- Finkelstein test (the test is specific for de Quervain’s tendonitis and consists in the occurrence of characteristic pain when clenching a fist and trying to bend the hand in a certain direction);
- The results of the diagnostics are clarified with the help of a physical examination (de Quervain’s tendonitis is characterized by soreness and puffiness in the wrist joint, aching when flexing and extending the thumb, and a number of other symptoms).