DE QUERVAIN’S TENOSYNOVITIS

DE QUERVAINS TENOSYNOVITIS

De Quervain’s tenosynovitis is a condition affecting the tendon sheath of the thumb. It is characterized by inflammation of the tendons of the thumb, specifically the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons.

Definition: De Quervain’s tenosynovitis is an inflammatory condition of the tendons of the thumb, caused by friction and compression of the tendons as they pass through a narrow tunnel in the wrist.

Types:

• Primary De Quervain’s tenosynovitis: This is the most common type, affecting the EPB and APL tendons.
• Secondary De Quervain’s tenosynovitis: This type is caused by other conditions such as thyroid disease, rheumatoid arthritis, or trauma.

Causes:

• Repetitive strain injury
• Trauma to the wrist or thumb
• Prolonged activities that involve gripping or twisting of the wrist
• Pregnancy or childbirth
• Systemic diseases such as rheumatoid arthritis or thyroid disease

Clinical Features:

• Pain and tenderness over the radial styloid process
• Pain and tenderness over the tendons of the thumb
• Pain and stiffness in the thumb and wrist
• Weakness or numbness in the thumb
• Difficulty grasping or gripping objects
• Swelling or redness in the affected area

Investigations:

• Physical examination and history taking
• Imaging studies such as X-rays or ultrasound to rule out other conditions
• Tenderness to palpation over the radial styloid process
• Pain with resisted thumb extension or abduction

Complications:

• Chronic pain and stiffness
• Nerve damage
• Tendon rupture
• Wrist or thumb deformity

Management:

• Conservative management:
  • Rest and ice
  • Physical therapy to improve range of motion and strength
  • Oral or topical corticosteroids to reduce inflammation
  • Splinting to reduce stress on the tendons
• Surgical management:
  • Release of the compressed tendons
  • Repair of damaged tendons
  • Tenosynovectomy to remove inflamed tissue

Treatment:

• Conservative treatment is usually the first line of treatment
• Surgery may be necessary if conservative treatment fails or if there is significant damage to the tendons or surrounding tissue

Blood Supply:

• The blood supply to the EPB and APL tendons comes from the radial artery
• The radial artery also supplies blood to the surrounding soft tissues

Nerve Supply:

• The EPB and APL tendons are innervated by the posterior interosseous nerve (PIN)
• The PIN is a branch of the radial nerve

Clinical Anatomy:

• The EPB and APL tendons pass through a narrow tunnel in the wrist, known as the first dorsal compartment
• The first dorsal compartment is bounded by the radial styloid process and the wrist extensor tendons

Homoeopathic Therapeutic Medicines:

• Arnica montana: for inflammation and pain
• Rhus toxicodendron: for stiffness and swelling
• Ruta graveolens: for pain and inflammation
• Bellis perennis: for joint pain and inflammation

Surgical Steps: 1 → Incision is made over the first dorsal compartment 2 → The tendon sheath is identified and released 3 → The EPB and APL tendons are mobilized and repaired 4 → The tendon sheath is then closed