De quervain's disease

 

de Quervain's Disease

What is de Quervain's Disease? Once called Washer Woman's Sprain, this condition now bears the name of the Swiss surgeon, Fritz de Quervain (da cur vains ) who wrote about it in 1895.  De Quervain's disease is a painful inflammation of the tendons in the wrist.  From the drawing on the right, one can see that the tendons connected to the thumb bones are encased in lubricated sheaths, or sleeves, through which the tendons slide. With repetitive or excessive movements such as hand twisting and forceful gripping, the lubrication system may malfunction which allows friction to develop between the tendons of the thumb and their common sheath. The repetitive friction causes tendon thickening which interferes with the smooth gliding motion as these tendons are called upon to move the thumb. What causes De Quervain's Disease? De Quervain's disease is caused by anything that causes swelling or thickening of the tendons. Repetitive trauma, overuse, or an inflammatory process are likely causes, but frequently, the cause of the disease is unknown. In other cases, scar tissue from an injury to the hand can make it difficult for the tendons to slide easily through their sheaths.  Who gets De Quervain's Disease? De Quervain's disease occurs most often in individuals between the ages of 30 and 50. Women are afflicted with it 8 to 10 times more often than men. People who engage in repetitive activities requiring sideways motion of the wrist while gripping the thumb, as in hammering, skiing, some assembly line jobs, etc., may be predisposed to developing this disorder. What are the symptoms of De Quervain's Disease? Pain over the thumb side of the wrist is the primary symptom. It may occur either suddenly or gradually, and it may radiate into the thumb and up the forearm. It may become worse as the thumb is moved away from the hand, and becomes more intense with the use of the hand and thumb, especially with any forceful grasping, pinching, or twisting. Swelling over the thumb side of the wrist may be present, as well as some "snapping" when the thumb is moved (caused by the tendons moving through the constricted sheaths. Because of the pain and swelling, there may be some decreased thumb motion. How is De Quervain's Disease diagnosed? Our doctors usually diagnose de Quervain's disease with a physical examination. Most of the time no additional tests are required.  What is the treatment for de Quervain's disease? If at all possible, you must change or stop all activities that cause your symptoms. Take frequent breaks when doing repeated hand and thumb actions. Avoid repetitive hand motions such as heavy grasping, wringing, or turning and twisting movements of the wrist. Keep the wrist in a neutral alignment. In other words, keep it in a straight line with your arm, without bending it forward or backward. Our doctors may first try to reverse the course of the disease with a 3 to 6 week trial on an anti-inflammatory medication while the thumb and wrist are rested by wearing a wrist and thumb splint. He may also inject the inflamed area with a steroid to help decrease the inflammation. If all else fails, you may need surgery. The goal of surgery is to give the tendons more space so they no longer rub on the inside of the tunnel. To do this, the surgeon performs a surgical release of the roof of the tunnel. This is usually performed on an outpatient basis. A prescription for pain medication will be provided following surgery. You should expect some pain, especially the first three days. The bulky dressing is removed at one of our offices a few days after surgery, and an exercise program for the thumb and wrist is started. It is important to do the exercises as prescribed. De Quervain's disease rarely recurs after proper surgical intervention. Complications may occur if not treated.