Symptoms
Tendovaginitis stenosans de Quervain manifests as acute pain, swelling and inflammation at the base of the thumb at the wrist. The pain is usually unilateral and occurs mainly with certain loads and movements, for example, when grasping and sometimes also at rest. The discomfort is restrictive, can radiate into the arm and fingers, and is accompanied by insensitivity. The name is derived from the Swiss surgeon Fritz de Quervain, who first described the condition in 1895.
Causes
It is caused by overwork and frequent repetitive activity, for example, at the computer, at work, or in hobbies. The condition often occurs in mothers who are caring for their infants (it can also occur in fathers). Lifting the children is a heavy and unaccustomed burden. It is a disease and inflammation of the tendon sheaths of the two tendons that run through a kind of tunnel at the wrist. The tendons of the abductor pollicis longus muscle of the extensor pollicis brevis muscle are affected. The structural changes interfere with the sliding of the tendons through the first extensor tendon compartment.
Diagnosis
The diagnosis is made in medical treatment based on the patient’s history, physical examination, and with the Finkelstein test. This involves clenching the hand into a fist, placing the thumb, and moving the hand toward the little finger, which triggers pain at the wrist. Additionally, when pressure is applied to the area, pain occurs and the disorder is often palpable.
Nonpharmacologic treatment
The triggering factors (repetitive actions, overloading) should be reduced as much as possible.
- Heat, warm baths
- Immobilization and relief by applying a bandage, splint or plaster cast
- Physiotherapy, exercises
- Occupational therapy, conversion of the workplace
- Physical therapy
- Minor surgery as a means of 2nd choice.
Drug treatment
Pain medication:
- Such as NSAIDs (eg, ibuprofen, diclofenac, naproxen) and acetaminophen are used for symptomatic treatment of pain. NSAIDs have additional anti-inflammatory properties.
Glucocorticoids:
- Such as triamcinolone acetonide are injected locally in medical treatment. They are anti-inflammatory and relieve pain.
Topical NSAIDs:
- Such as a diclofenac gel are applied locally to treat pain and reduce inflammation. They are better tolerated than systemic administered NSAIDs.
Herbal medicines:
