De quervain’s disease: treatment, symptoms, syndrome
What is characteristic of the disease de quervain — symptoms and treatment
The disease de quervain’s (tenosynovitis) is a syndrome characterized by inflammation of the tendons of the thumb.
In this disease there is friction, swollen tendons and their covering of the narrow tunnel in which they move, the resulting pain in region of base of first finger.
To understand the process briefly describe the anatomy of the movements of the brush.
The contraction of the muscles of the forearm provides flexion and extension of fingers. Transmission of the contraction of the muscles on the fingers and bringing them into the movement exercise the tendons of muscles, flexor muscles and extensor muscles.
The tendons of the flexors pass to the toes through the Palmar surface of the hand and of muscles-extensors – through back.
Hold tendons in position on the brush carry the transverse ligament. On the back side of the brush – back bunch. Each group of tendons in the dorsal ligament of the wrist is in a separate channel.
For example, in the first channel are fibrous tendons going to the first finger.
In simple words, de quervain’s tenosynovitis causes inflammation of the ligaments, swelling and thickening. As a consequence, the channel links becomes too small, there are symptoms of the disease, the dysfunction of the entire hand.
Where lie the true causes of the syndrome
There is no exact reason causing tenosynovitis.
However, I believe that the activity associated with constant repetitive movements of the hands, whether it be Golf, work in the garden, carrying the baby, the condition may be exacerbated.
Therefore the disease is sometimes called abroad «thumb gamer» or «mother’s wrist».
Possible causes of the disease:
- hand trauma as a result of injury forms scar tissue that can limit movement of the tendon;
- inflammatory diseases of the joints;
- the constant stress on the wrist joint.
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The greatest risk of disease prone individuals aged 30 to 50 years, more women, it might have to do with pregnancy and newborn care, its repeated rise on hands.
The signs of the disease
The de quervain’s disease has characteristic symptoms:
- soreness at the site of attachment of the base of the thumb;
- swelling at the base of the thumb;
- hindered the movement of your wrist while carrying out the daily Affairs;
- pain increases with pressure on the affected area.
The main symptom is tenderness of the wrist joint when pressure is applied to the base of the first finger brush, especially when trying to hold any object.
In the initial stages of the disease pain appear only when the forced extension of the thumb and in the implementation of a sharp and intense strokes.
After a time the pain becomes permanent or occurs even in the most minor movements.
The pain may radiate to the hand, shoulder, forearm and neck area. Sometimes the spread of pain occurs at the back surface of the thumb to the tip.
Sometimes there are night pain when during sleep in some awkward motion there is a sharp pain in the wrist. For patients characteristic reduced grip strength of the subject brush the affected arm.
If long not to treat the syndrome, the pain may spread to the forearm. Any movement involving the thumb will cause pain that leads to reduced capacity to work.
Diagnosis of disease is based on samples and tests:
- The Finkelstein Test. The first fingers clench into the fist and produce retraction of the brush in the direction of the little finger or thumb. In the event of a sharp pain in the wrist joint of the first finger in the abduction of the brush test is considered positive.
- Test on the tense abduction. When pressed from the back side on the thumb so that the finger was given to palm, on the sick side even with a slight pressure on the finger will arise sharp pain, and the finger with virtually no resistance will be brought to the palm of your hand, and the healthy hand finger will vigorously resist the pressure.
- To test the ability to hold objects with the help of the thumb. The patient tries to hold the object between thumb and index finger of the patient and the healthy hand. When you try pulling the held object, it becomes apparent that a sore arm is much weaker holding an object. While trying to keep the subject withdrawn from the patient’s hands, there is a sharp pain in the wrist joint in the thumb area.
- X-ray examination. In the initial stages of the disease on radiographs detect thickening of soft tissues in two times. In the long course of the disease are visible signs of change in bone and periosteum in the wrist joint in the region of the thumb.
Treatment of de quervain syndrome may conservative and surgical way.
First and foremost, patients cease to perform physical activity.
Is immobilization of the affected bundles so that the first finger was in a bent position and was located opposite the second and third fingers, the brush should be slightly flattened in the back.
Therefore, for immobilization using plaster bandage imposed from finger tips to mid forearm.
Refusal of exercise and immobilization to prevent further trauma to the joint, but treatment is not.
Over the next two to three weeks of stay hand in a cast is necessary to carry out adequate conservative therapy of the disease.
The disease is the inflammatory process ligaments, so for the treatment of tendons apply physiotherapy, anti-inflammatory drug and novocaine blockade.
However, these tools are not much efficient in the long course of the disease, also often after a short period of remission the disease occurs again.
A good anti-inflammatory effect of local injection of hydrocortisone, hold them up to six times with a break of two or three days.
Always conservative treatment is followed by rehabilitation lasting from two to four weeks.
Surgical treatment of pathology
With the ineffectiveness of conservative treatment is quite often resort to surgical treatment of the disease de quervain. With bilateral lesions also operative treatment.
The operation can be carried out in an outpatient setting using local anesthesia. During the operation, produce the dissection of the ligamentous channel and the release from compression of the tendons.
If you run the disease, the person can become disabled.
Therefore at occurrence of symptoms should immediately consult a doctor.
In surgical treatment there is a small probability of occurrence of complications such as the formation of painful scar and a violation of the movements of the thumb.
To reduce the likelihood of the syndrome, it is necessary to reduce the physical stress associated with repetitive twisting and grasping movements.