Brief overview
- Symptoms: Pain below the thumb, especially when holding and gripping; sometimes palpable and audible rubbing and crunching; blockage of the thumb
- Treatment: Conservative with immobilization (sometimes in a cast); local painkillers, possibly anti-inflammatory cortisone injections; surgery in more severe cases
- Causes and risk factors: Overloading and incorrect loading of the joint, other factors such as degenerative processes and suspected connection with the female sex hormone oestrogen (women are more frequently affected)
- Diagnosis: Based on the symptoms, Finkelstein test; rarely X-ray and ultrasound
- Prognosis: Often healing with immobilization and pain relief; surgery in more severe cases often with a good prognosis
- Prevention: Warm-up, stretching, breaks, variety, avoid overloading and incorrect loading, use technical aids and work techniques that are easy on the joints and back
What is tendovaginitis de Quervain?
In a healthy state, both tendons glide smoothly through the tendon compartment, surrounded by lubricating fluid. If the tendons are injured as a result of trauma or overstressed by repetitive strain, it is possible for the tendon compartment to swell: the tendons become constricted. To make matters worse, the first tendon compartment is sometimes divided, i.e. a small septum runs between the two tendons, which further reduces the space available.
Tendovaginitis de Quervain affects women much more frequently than men. This is why it is sometimes still referred to colloquially as “housewife’s thumb”. It occurs more frequently from the age of 40.
How does tendovaginitis de Quervain manifest itself?
Typical symptoms that indicate tendovaginitis de Quervain are pain in the wrist below the thumb. Particularly when holding and gripping firmly, there is sometimes severe pain at the level of the inner wrist knuckle (styloid process of the radius), which radiates into the thumb. Every movement of the thumb often causes pain. For example, wringing out a towel is very painful. The affected area is also swollen.
How is Tendovaginitis de Quervain treated?
Tendovaginitis de Quervain is initially treated conservatively. This is especially true in the early stages, when the symptoms are not yet so pronounced. It is particularly important to avoid activities that cause pain, especially movements that involve bending the hand towards the thumb. It is also possible to immobilize the thumb in a plaster cast for up to 14 days.
In some cases, splints or bandages are used. It is important to immobilize the joint effectively. Local anti-inflammatory ointments can be applied to combat the inflammation.
If this does not improve the symptoms of tendovaginitis de Quervain, the patient is given anti-inflammatory cortisone injections, usually together with a local anaesthetic. However, caution is advised because the injections may damage the tendons.
If the pain recurs and cortisone therapy is unsuccessful, doctors usually recommend surgery. This can be performed on an outpatient basis. So that the surgeon can see the nerves, tendons and other structures better, the procedure is performed in a haemostasis. This means that the patient is given a pressure cuff on the upper arm to restrict the blood supply to the forearm.
Finally, a compression bandage is applied to the wrist and forearm. After about a week, it is possible for the patient to resume lighter activities. The hand and wrist can usually bear normal weight again around three weeks after the procedure.
Causes and risk factors
Tendovaginitis de Quervain is thought to occur when the thumb and thumb-side wrist are subjected to excessive strain or misuse. Prolonged bending of the hand can also constrict and squeeze the thumb extensor tendons. The tendons are then pressed against the edge of the retinaculum (a tight ligament in the wrist area), causing them to become irritated and swollen.
A classic example is parents who carry their child in their arms and support them with their hand. Intensive piano playing, keyboard work, knitting and other housework are also common causes. This is why the condition is colloquially known as “housewife’s thumb”.
However, studies have shown that other factors also play a role. For example, experts suspect degenerative processes and a connection with hormonal influences.
It is also possible that higher doses of antibiotics from the fluoroquinolone group may have an influence on the development of tendonitis in older patients.
Examinations and diagnosis
In addition to local soft tissue swelling and tenderness, various tests can be used in the clinical examination. Tendovaginitis de Quervain is characterized by the so-called Finkelstein test.
Finkelstein test
In the so-called Finkelstein test, the fist is closed around the thumb of the affected hand. Then, with the fist closed, the wrist is quickly tilted towards the tip of the thumb. If this causes severe electrifying pain (= Finkelstein’s sign), this indicates tendovaginitis de Quervain.
Imaging procedures
Further diagnostic steps such as an X-ray examination are generally not necessary. However, in some cases an X-ray is useful to rule out other diseases such as osteoarthritis. Otherwise, in unclear cases, the tendons and surrounding structures can be clearly visualized with an ultrasound examination (sonography).
Course of the disease and prognosis
Prevention
Tendovaginitis de Quervain is probably caused not only by overuse or incorrect use, but also by other factors that are not yet known exactly. It is therefore not possible to reliably prevent the disease.
However, it is possible to do something about the aspect of overloading and incorrect loading, which often cause general problems with tendons, joints or the spine. It makes sense to take more frequent breaks or to provide variety in movement sequences and activities, especially when performing repetitive tasks. Warming up and stretching before exerting yourself at work, doing sport or playing music helps to avoid problems with tendons and joints.
Last but not least, it is important to provide relief. This can be achieved with special work techniques, for example when lifting and transporting loads, or by using technical aids. These include dynamic office chairs, footrests or palm rests in front of the keyboard – or tools that simplify work processes.
