De Quervain's disease is a pathology characterized by inflammation of the tendons on the thumb. The disease manifests itself gradually, it is characterized by a rather slow development. Sometimes it takes weeks or even months before a visit to a doctor.
Description of the disease
De Quervain's disease (chronic tenosynovitis or stenosing ligamentitis) is a pathology that is characterized by a gradual narrowing of the canal where the tendons of the thumb pass. The disease is accompanied by inflammation of the so-called tendon sheaths. The disease occurs as a result of a constant load on the hand, often in connection with the performance of professional activities. Due to pain, patients are unable to perform some movements involving the entire hand.
The periodic contraction of the muscles of the forearm makes it possible to flex/extend the fingers. The tendons of the flexor muscles (approach the fingers through the palmar surface) and extensor muscles (pass through the back of the hand) are responsible for these movements. The transverse ligaments keep the tendons in the desired position. The dorsal ligament is localized on the same side of the hand. Each group of tendons in the latter is in a separate canal. The thumb is actively involved in the daily life of a person. His tendons take on the greatest load. De Quervain's disease provokes sequential inflammation of the ligaments, their thickening and swelling. As a result, the canal becomes excessively small, symptoms of the disease appear, and the functioning of the entire hand is disrupted.
What causes the development of pathology?
The exact causes of this disease remain unexplored to the end. It is suggested that constant repetitive hand activity (golfing, gardening, childcare) may aggravate this condition. Therefore, sometimes the disease is called "mother's wrist."
Also, experts identify a number of factors contributing to the development of pathology, namely:
- Injuries and mechanical damage to the hand.
- Diseases of the joints of an inflammatory nature (arthritis, arthrosis).
- Constant load on the area of the wrist joint.
- Hormonal restructuring of the body (more often during menopause).
- Anatomical features of the musculoskeletal system.
Who is at risk?
The highest risk of developing this pathology in people aged 30 and approximately 50 years. De Quervain's disease is more often diagnosed in the fair sex during pregnancy and caring for a newborn.
What are the signs of pathology?
The main symptom of this disease is pain in the area of the wrist joint from the side of the thumb. When turning the brush, discomfort may intensify. Pain often radiates to the forearm and neck area.
Finkelstein's symptom is considered a hallmark of the disease. A man, clenching his hand into a fist, puts his thumb inside. If the next attempt to move the hand to the side is accompanied by a sharp pain, de Quervain (illness) can be confirmed.
On palpation of the joint, there is a slight swelling, pain on the affected side.
The main mistake of many patients is not seeking qualified help, but simply immobilizing the hand. For these purposes, tight bandages, special wristlets are used. In this case, the onset of the disease is the cause of disability. Patients are unable to perform even the most common household chores (peeling potatoes, washing, unbuttoning buttons, etc.).
Diagnosis
De Quervain's disease should not be ignored. Symptoms of a pathology that appear for several days in a row should alert and become a reason for an immediate visit to a doctor.
At the consultation, the specialist performs a physical examination of the affected area, may ask a number of clarifying questions (when the pain appeared, their possible causes). To confirm the diagnosis, the doctor performs several tests.
- Tense abduction. The specialist presses on the thumb from the back so thatbring it to the palm of your hand. On a perfectly he althy hand, the finger should resist pressure. In the case of pathology, soreness appears when touched.
- The ability to hold objects. The patient should take an object in each hand. If you pull it slightly, the he althy hand will hold the object with more force, which cannot be said about the sick one.
- X-rays can also confirm de Quervain's disease. A photo (snapshot) of the hands allows you to identify the presence of thickening of soft tissues, changes in the periosteum.
Conservative Therapy
First of all, patients are advised to stop their previous activities with mandatory immobilization of the affected area. Immobilization of the hand should be performed in such a way that the thumb is constantly in a bent position in relation to the index and middle. For these purposes, the best solution is to use a plaster cast, which is applied to the middle of the forearm. Such immobilization only prevents the joint from possible injury. Additionally, appropriate conservative therapy should be carried out.
Inflammatory changes in the ligaments underlie such pathologies as de Quervain's disease. Treatment involves the use of physiotherapy procedures (paraffin, ultrasound with hydrocortisone). In addition, anti-inflammatory drugs (Ibuprofen, Naproxen), steroid injections (Hydrocortisone) are prescribed.
When is surgery required?
Surgery is recommended when conservative therapy fails or bilateral lesions occur.
The operation is carried out in stationary conditions using a local variant of anesthesia. Before starting direct anesthesia, the doctor marks the most painful area with a special marker. Then novocaine is injected, and a transverse incision is made over the area of the so-called styloid process, which passes through this point. With a blunt hook, the subcutaneous tissue along with the veins is extremely carefully retracted to the side, and the dorsal ligament is exposed. The doctor dissects it and partially removes it. Often, with a long course of the disease, adhesions of the tendon to the tendon sheath occur. In this case, all existing adhesions are excised. The wound is sutured, a scarf bandage is applied. The sutures are removed after about 10 days, the ability to work is finally restored on the 15th day.
It must be taken into account that de Quervain (disease) is usually caused by a pathological process in the area of the annular ligament. If, after direct surgical intervention, the patient continues to overload the arm, the likelihood of a relapse increases several times. That is why patients are advised to reduce activity, and sometimes even change the type of professional activity.
Possible Complications
What happens if de Quervain's disease is not treated? More and more hands over timeare involved in the pathological process, and the person loses his usual ability to work. That is why it is so important when primary symptoms appear that indicate an illness, to seek qualified help from the appropriate specialist. In the case of surgery, there is still a small chance of complications such as the formation of a painful scar and impaired movement of the thumb.
Preventive measures
How to prevent the development of the disease? First of all, doctors recommend that all those who are at risk reduce physical activity associated with grasping movements of the hand. In addition, inflammatory joint diseases should not be started. In case of injuries or mechanical damage to the hand, it is important to seek help from a doctor and undergo a course of therapy. Only by observing all the above recommendations can the development of pathology be prevented.
Conclusion
In this article, we described what symptoms accompany de Quervain's disease. Surgery for this pathology is recommended in 80% of cases. However, timely conservative treatment can eliminate the disease and minimize the development of complications.
We hope that all the information provided will be really useful for you. Stay he althy!
