De Quervain’s Tendinosis is a medical condition due to the irritation and inflammation of the tendons located at the base of the thumb. Tendinosis simply refers to swelling of the tendons and this will ultimately result in pain and discomfort for patients. This pain is further intensified when activities involving the thumb is initiated such as gripping a plastic bag or clenching a fist.
Located in our thumb are 2 main fibrous connective tissues known as the tendon. The tendons are the ones responsible for attaching our muscles to bones. In order to provide cushioning support, synovium fluid is coated on the tendons so that they can slide easily. When the tendons swell or thickens, friction will be increased and this will result in tendinosis.
In the initial stages of tendinosis, the pain will be random. It may appear slowly or suddenly and will travel from the wrist all the way up to the forearm. After a few days, presence of swelling will be obvious over at the thumb side of the wrist due to an excess of bodily fluid accumulated. When the thumb is in use, there may be feelings of instability and a snapping sound might be heard. Due to the swelling and pain, the thumb and entire wrist may be difficult to use.
The main aim of treatment is simply to reduce irritation and swelling that is responsible for pain. Non-surgical treatment will be administered first to see if patients can respond well.
Splints act as immobiliser to properly rest the thumb and wrist to prevent further aggravation to the condition. It will be worn over a period of several weeks until signs of improvements are seen.
Anti-inflammatory medication as its name suggests are administered either orally or locally through injection to reduce inflammation, swelling and ultimately relieving pain.
Corticosteroids will be injected directly into the site of the inflamed tendon. The corticosteroids will enter into the cells and combine with the steroid receptors, inhibiting the synthesis of proteins which are responsible for swelling.
Surgery will be required for cases that do not respond well to non-surgical means. An axillary block will be performed to put the hands to sleep. A small incision will be made and the wrist will be thoroughly cleaned with anti-bacterial solution. The tunnel will be opened up to make space for tendons so that it does not rub against the tunnel.