Related articles: De Quervain syndrome
Definition
De Quervain syndrome is a chronic inflammatory disease that involves the tendons of the long abductor muscles and the short extensor of the thumb, in addition to the synovial membrane that covers them. This form of tenosynovitis involves a progressive narrowing of the tendon sheath, at the point where it passes over a bone protrusion called radium styloid. Thus, increasing in volume, the synovial membrane contributes to the irritation of the tendons, as it causes painful friction during tendon flow.
The causes that determine the onset of De Quervain syndrome can be multiple and include sudden functional overloads and repetitive activities involving flexion-extension of the thumb (sewing, playing a musical instrument, using the mouse or the keyboard of the computer etc.). Also the individual predisposition and some rheumatic diseases can favor the onset of the disorder.
Most common symptoms and signs *
- Hammer finger
- Hand and wrist pain
- Articolar pains
- Tingling in the right hand
- Tingling in the hands
- Joint swelling
- Hypoaesthesia
- Paresthesia
- Joint stiffness
Further indications
The main symptom of De Quervain syndrome is pain in the lateral aspect of the wrist and at the base of the thumb. This manifestation can radiate to the forearm and is accentuated, in particular, when taking movements with the thumbs and inclination of the wrist.
In many cases, a swelling appears along the course of the tendons; the swollen area appears compact and extremely painful to pressure. Edema can also compress the sensory branch of the radial nerve, which flows just above the sheath, causing a tingling or loss of sensation in the thumb. If the disease persists, the inflammatory process leads to fibrosis.
This can cause a snap or block phenomenon with abduction or thumb extension.
If De Quervain syndrome is neglected and not treated properly, it can develop into rhizoarthritis (arthrosis of the thumb).
The diagnosis of De Quervain syndrome is clinical. The Finkelstein test records the degree of pain felt by the patient: the maneuver consists of closing the hand in a fist, tightening the fingers around the thumb and flexing the wrist towards the little finger. In fact, in the subject suffering from De Quervain syndrome, thumb movements are difficult due to intense pain, which is more intense when the wrist is tilted. The ultrasound examination of the area allows to accurately highlight the inflammatory changes of the tendons and their relationships with the walls of the synovial sheath.
In the early stages, functional rest and taking anti-inflammatory drugs can resolve the symptomatology. In the most important cases, however, topical administration of corticosteroids by infiltration can be used. When symptoms do not improve with conventional therapies, it is necessary to resort to surgical treatment to favor the correct sliding of the tendons inside the sheath.
