Tendovaginitis de Quervain (Quervain’s disease, housewife’s thumb) is a tendonitis in the area of the first bony tendon on the wrist. The cause is overuse of the thumb. Typical are pain, especially on the wrist below the thumb. The treatment is initially conservative. For recurrent pain, surgery may be considered. Everything you need to know about Tendovaginitis de Quervain can be found here.
Tendovaginitis de Quervain: description
The Swiss surgeon Fritz de Quervain was the first to describe tendonitis in 1895, now known as Tendovaginitis de Quervain (more precisely: Tendovaginitis stenosans de Quervain). It concerns the first of a total of six tendon compartments on the back of the hand. Two sinews pass through this tendon compartment: the tendons of the short extensor extensor muscle (extensor pollicis brevis) and the long abductor pollicis longus.
In the healthy state, both tendons glide smoothly through the tendon compartment, surrounded by lubricating fluid. If the tendons are injured or traumatized by recurring strains, the tendon may swell. The tendons are narrowed. To make matters worse, the first tendon compartment is sometimes divided, so a small septum (septum) runs between the two tendons, making the space for already reduced in advance.
Quervain tendosagitis is also known colloquially as the “housewife’s thumb” because women are affected about eight times more frequently than men. It occurs frequently from the age of 40 years.
Tendovaginitis de Quervain: Symptoms
Typical symptoms of Tendovaginitis de Quervain are wrist pain below the thumb. Especially when holding and grasping firmly, severe pain occurs at the level of the styloid process (styloid processus), radiating into the thumb. Any movement of the thumb can cause pain. For example, wringing a towel can be very painful. The affected area is also swollen.
If the Tendovaginitis de Quervain is very pronounced, sufferers usually describe a sensible and audible rubbing. In the later stage, the tendons can be completely blocked and no longer bend. Most of the complaints often last several weeks or even months. Patients often report that there has been a heavy overload or overuse of the wrist and hand before the onset of symptoms.
Tendovaginitis de Quervain: causes and risk factors
The cause of Tendovaginitis de Quervain may be overuse with repetitive stretching and movement of the thumb as well as sideways movement of the wrist. Even a longer angle of the hand can narrow and push the thumbstretch tendons. A classic example is, for example, mothers who carry their child in their arms and support it with their hands. The tendons are then pressed against the edge of the retinaculum (a tight band around the wrist), causing them to become irritated and eventually swell.
In many cases, however, the cause of Tendovaginitis de Quervain remains unclear.
Tendovaginitis de Quervain: examinations and diagnosis
In addition to local soft tissue swelling and pressure pain, various tests can be used in the clinical examination. Characteristic of the Tendovaginitis de Quervain is the so-called Finkelstein test.
Tendovaginitis de Quervain: Finkelstein test
The Finkelstein label can be used as a clinical test to diagnose Tendovaginitis de Quervain. The fist is formed around the thumb of the affected hand. Then, with your fist closed, tilt the wrist quickly towards the tip of the thumb (after ulnar). If this triggers violent electrifying pains, this speaks for a Tendovaginitis de Quervain.
Tendovaginitis de Quervain: Imaging procedures
Further diagnostic steps, such as an X-ray, are generally unnecessary. The X-ray may be useful in some cases, if you want to exclude a mechanical blockage in the joint. Otherwise, in unclear cases, an ultrasound scan (sonography) can clearly visualize the tendons and surrounding structures.
Tendovaginitis de Quervain: treatment
Tendovaginitis de Quervain is initially treated conservatively. This is especially true at an early stage, when the symptoms are not as pronounced. It is particularly important to avoid pain-inducing activities, especially movements that are associated with the angle of the hand to the thumb side. For this, the thumb can be immobilized in a plaster cast. To combat the inflammation, local anti-inflammatory drugs can be applied as an ointment.
If the symptoms of Quervain’s Tendovaginitis do not improve, the patient receives anti-inflammatory cortisone injections (usually together with a local anesthetic). However, care should be taken because the injections can damage the tendons.
If the pain recurs and the cortisone therapy is unsuccessful, surgery is usually recommended. It can be performed on an outpatient basis. In order for the surgeon to better see the nerves, tendons and other structures, the procedure is performed in bloodless. This means that the patient gets a pressure cuff on the upper arm to throttle the blood supply to the forearm. Then a small skin incision is made in the longitudinal direction over the affected extensor tendon compartment. The first extensor tendon pocket is then split. If there is an additional septum between the tendons, it will also be severed. Before the surgeon sutures the wound, he checks whether the tendons can now slide freely.
At the end, a compression bandage is applied to the wrist and forearm. After about a week, the patient can start with lighter activities. About three weeks after the procedure, the hand and the wrist are usually normally loaded again.
Tendovaginitis de Quervain: Disease course and prognosis
The operation improves the complaints of the Tendovaginitis de Quervain in most cases quickly: the pain disappears and the mobility is restored.