De Quervain Tenosynovitis

Description

De Quervain tenosynovitis is characterized by pain on the side of the wrist and base of the thumb from inflammation of one or two tendon sheaths, which cover the tendon, or strain of one or two tendons to the thumb: the extensor pollicis brevis (EPB) or abductor pollicis longus (APL). The lining of the sheath secretes a fluid that lubricates the tendon. When the lining becomes inflamed, the tendon cannot glide smoothly in the sheath. The EPB tendon is the anchor of the EPB muscle, which is important for straightening the thumb, whereas the APL tendon is the attachment for the APL muscle, which is important for moving the thumb away from the index finger. The tendons pass across the wrist through a canal over the wrist, just beneath the base of the thumb. When these tendons become swollen or inflamed, usually from overuse, pain occurs as the tendons pass through the tight canal.

Common signs and symptoms

• Pain, tenderness, swelling, warmth, or redness over base of the thumb and at the thumb side of the wrist

• Pain is worse with straightening the thumb or moving it away from the index finger against resistance, as well as with pinching or gripping; also, pain when putting the thumb within a fist of the same hand and bending the wrist away from the thumb

• Locking or catching of the thumb

• Limited motion of the thumb

• Crepitation (a crackling sound) when the tendon or thumb is moved or touched

Causes

• Tenosynovitis becomes more likely with repeated injury to the thumb muscle–tendon units and with repetitive motions of the hand and wrist from friction of the tendon within the sheath.

• It can also be due to a sudden increase in activity or change in activity.

Factors that increase risk

• Sports that involve repetitive hand and wrist motions, including golf, bowling, tennis, squash, and racquetball

• Heavy labor

• Poor physical conditioning (strength, flexibility)

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