de Quervain Syndrome
Radial styloid tenosynovitis, more commonly known as “de Quervain syndrome”, is an inflammatory condition affecting the tendons that straighten the thumb. The name comes from a Swiss surgeon, Fritz de Quevain, who first described the condition in the early 1900s.
Patients with de Quervain syndrome have pain along the radial side (thumb side) of the wrist during grasping, twisting or thumb motions. The region is often tender when pressed upon, and oftentimes noticeably swollen.
The cause is unknown, but may be due to overuse or minor trauma to the tendons of the thumb. The tendons to the thumb pass through a narrow tunnel alongside the wrist, and when the tendons are irritated or inflamed, they glide less smoothly and comfortably. Other names given to the condition include “texting thumb” and “Nintendinitis”, highlighting the link between overuse of the thumb and symptoms. It is known to be more common in women, and oftentimes seen during and after pregnancy due to overuse, hormones, or fluid changes.
Thumb spica splint - this limit thumb and wrist motion, which allows the tendons to rest, thereby decreasing inflammation
Anti-inflammatories - (such as ibuprofen or naproxen – if medically safe)
Steroid injection - the most effective non-surgical way of decreasing pain and eliminating symptoms. A cortisone injection into the tunnel bathes the tendons in a strong anti-inflammatory fluid. This shrinks the inflamed tendons, and can restore normal, pain-free tendon gliding.
If non-operative solutions fail, surgery may occasionally be warranted. This involves dividing, or releasing, the roof of the tunnel through which the thumb tendons pass.
This creates more space for the tendons to glide smoothly, resulting in prompt improvement of the tendonitis pain.
This is a quick, outpatient procedure done through a small incision (<1 inch) over the wrist.
Absorbable sutures are placed underneath the skin, and Dermabond (medical grade "Super Glue") is used to seal the incision. A bandage is placed which remains in place for 3 days.
The hand can be used for normal light activities immediately, and you can get the incision wet once the bandage is removed. More demanding activities (e.g. lifting weights, gardening, manual labor) should be avoided until the skin heals (~10 days).
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.