De Quervain Tendinitis : Tenosynovitis of the sheath or tunnel that surrounds two tendons that control movement of the thumb BlackBerry thumb, texting thumb, gamer's thumb, washerwoman's sprain, radial styloid tenosynovitis De Quervain disease, de Quervain's tenosynovitis, de Quervain's stenosing tenosynovitis Mother's wrist, or mommy thumb

Signs and Symptoms : Pain at the radial side of the wrist, spasms, tenderness, occasional burning sensation in the hand Swelling over the thumb side of the wrist, and difficulty gripping with the affected side of the hand The onset is often gradual. Pain is made worse by movement of the thumb and wrist, and may radiate to the thumb or the forearm.

Causes I : Occupational risk factors is debated.[ Personal and work-related factors were associated with de Quervain's disease in the working population Wrist bending and movements associated with the twisting or driving of screws were the most significant of the work-related factors The thumb is held in abduction and extension to be predisposing factors

Causes II : Workers who perform rapid repetitive activities involving pinching, grasping, pulling or pushing have been considered at increased risk. Specific activities that have been postulated as potential risk factors include intensive mouse/trackball use and typing, including bowling, golf and fly-fishing, piano-playing, and sewing and knitting. Women are affected more often than men. The syndrome commonly occurs during and after pregnancy. Contributory factors may include hormonal changes, fluid retention and—more debatably—lifting.

Pathophysiology : The mucous sheaths of the tendons on the back of the wrist.De Quervain syndrome involves noninflammatory thickening of the tendons and the synovial sheaths that the tendons run through. The two tendons concerned are the extensor pollicis brevis and abductor pollicis longus muscles. These two muscles run side by side and function to bring the thumb away from the hand; the extensor pollicis brevis brings the thumb outwards radially, and the abductor pollicis longus brings the thumb forward away from the palm.

Pathophysiology : Affect the tendons of these muscles as they pass from the forearm into the hand via a fibro-osseous tunnel (the first dorsal compartment). Evaluation of histopathological specimens shows a thickening and myxoid degeneration consistent with a chronic degenerative process, as opposed to inflammation. The pathology is identical in de Quervain seen in new mothers

Diagnosis : Based on history and physical examination X-ray rule out fracture, arthritis, or other causes Finkelstein's test is a physical exam maneuver used to diagnose de Quervain syndrome.

Finkelstein's test : The examiner grasps the thumb and sharply deviates the hand toward the ulnar side. If sharp pain occurs along the distal radius (top of forearm, about an inch below the wrist ).

Differential Diagnosis : Osteoarthritis of the first carpo-metacarpal joint Intersection syndrome—pain will be more towards the middle of the back of the forearm and about 2–3 inches below the wrist * Wartenberg's syndrome

Treatment : Most tendinoses are self-limiting Palliative treatments ( Splint that immobilized the wrist and the thumb to the interphalangeal joint and anti-inflammatory medication ) Physical and occupational therapists Corticosteroid injection was the first line of treatment Surgery (in which the sheath of the first dorsal compartment is opened longitudinally)

Treatment : UST, SWD, or other deep heat treatments, TENS, acupuncture, or infrared light therapy, and cold laser treatments. Teaching patients to reduce their secondary inflammation does not treat the underlying condition but may reduce their pain

Further Reference : Ilyas A, Ast M, Schaffer AA, Thoder J (2007). "De quervain tenosynovitis of the wrist". J Am Acad Orthop Surg. "The histopathology of de Quervain's disease". J Hand Surg [Br]. 23 (6): 732–4

Q & A Dr. 熊永萬 Dr. Bear