DeQuervain's Tendonitis

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Anatomy

The extensor tendons of the thumb connect the forearm muscles to the bones of the wrist and thumb. They are responsible helping to 'cock' or pull the thumb up when the forearm muscles contract. The tendons are surrounded by sheaths (paratendons) that protect the tendons from excessive friction.

Mechanism of Injury

Repeated or violent overloading of the Thumb extensor tendons and their sheaths results in micro-tearing of the tissues. Inflammation develops on surfaces between the sheath and tendon which produces pain and swelling. Healing is slow due to a repeated use of the hand and a poor blood supply in the tendons

Incidence

Signs and Symptoms

Localised pain around the 'anatomical snuff box' at the base of the thumb that can radiate down into the thumb, wrist or up the forearm.
Resisted thumb extension or gripping the thumb with the fingers of the affected side cause pain
Localised swelling at the base of the thumb and around the wrist crease
Increased warmth around the 'anatomical snuff box'
Pain and weakness on gripping objects in the hand
A palpable 'creaking' during movement of the thumb and wrist

Investigations

MRI scans are useful for determining the extent of inflammation in the tendon sheath
Diagnostic Ultrasound can detect the amount of swelling and inflammation between the tendon and the sheath in real-time

Therapy Treatment

Initial reduction of activity in the affected thumb, hand and wrist
Ice packs or ice massage to the localised area every 2 hours for at least 48 hours
Taping/Strapping to reduce the swelling and strain on the tissues
Ultrasound or laser therapy
Deep Frictions of the tendon and sheath tissues
Strengthening exercises for the hand, wrist and forearm muscles

Medical/Surgical

Non steroidal anti inflammatory drugs(NSAID'S)
Corticosteroid injections into the tendon sheath
Surgery to strip or repair damaged tendon and sheath tissue