DeQuervain's syndrome (patient information)

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 * Associate Editors-In-Chief: Jinhui Wu, MD, Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
DeQuervain's Syndrome is an inflammatory condition in the wrist. It is commonly caused by cumulative injury. Patients with DeQuervain's syndrome may feel pain, tenderness and swelling around thumb, even loss of function. Finkelstein’s test is common used to diagnose DeQuervain's syndrome. Treatments include medications to relieve pain, physical therapy to improve muscle strength. Surgery needs to be considered if patients with DeQuervain's syndrome do not respond well to medications or physical therapy. Most patients can recover after treatments.

What are the symptoms of DeQuervain's tenosynovitis?
Patients with DeQuervain's syndrome may experience the following symptoms:
 * Pain: Pain at the base of the thumb is the main symptom of DeQuervain's syndrome. The pain may be sudden or gradual, and may spread further into the thumb or the forearm.
 * Tenderness and swelling around thumb.
 * Loss of function in the thumb

Ganglion cyst also present with similar symptoms.

What causes DeQuervain's tenosynovitis?

 * Chronic overuse of your wrist i.e. activities like wringing out a cloth.
 * Direct injury to your wrist or tendon
 * Inflammatory arthritis, such as rheumatoid arthritis

It can be prevented by
 * Avoid to overuse or eccentrical load on the wrist.
 * Stretching may help you improve muscle flexibility.

Who is at highest risk?
The cause of DeQuervain's syndrome is the following:
 * Overuse of the wrist, activities such as that involve frequent lifting, wringing or peeling. For example, new mother is at risk of developing  DeQuervain's syndrome.
 * Eccentrical load on the wrist, activities such as lowering a child or putting a heavy stack of plates down.
 * Some occupations, such as office workers, musicians, carpenters.

When to seek urgent medical care?
Call your health care provider if symptoms of DeQuervain's syndrome develop.

Diagnosis
Your physician will diagnose DeQuervain's syndrome on the basis of following findings.


 * Medical history including location of pain, decreased or loss of function in the hand
 * Finkelstein’s test: This test is common used to diagnose DeQuervain's syndrome. In this test, the patient makes a fist with the fingers over the thumb then bents the wrist towards the little finger. Pain on the thumb side of the wrist means a positive result and suggests the diagnosis of DeQuervain's syndrome.

Treatment options
The goal of treatment of DeQuervain's syndrome is to relieve pain.
 * Rest, avoid to overuse or eccentrical load on the wrist.
 * Medications
 * Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to control inflammation and pain in patients with DeQuervain's syndrome. Usual drugs include ibuprofen, naproxen and indomethacin. Usual side effects are pain, bleeding and ulcers in upper gastrointestinal tract.
 * Corticosteroids: Corticosteroids are generally prescribed for patients who cannot take NSAIDs or have no good fesponse to NSAIDs. These drugs can be used by oral or by injection into the area to control inflammation and pain. Side effects of corticosteroids may include a decreased ability against infection and worse healing in the wound.


 * Physical therapy: It is an effective treatment for DeQuervain’s syndrome, including using heat/ice, ultrasound to mobilize the tendons and joints. Moreover, the therapist may do some progressive resistive exercises to help you recover.
 * Surgery: If the above treatments fail, surgery needs to be considered. Surgery can release the tendons and provide more space for them to move.

Where to find medical care for DeQuervain's tenosynovitis?
Directions to Hospitals Treating DeQuervain's syndrome

What to expect (Outlook/Prognosis)?
Prognosis of DeQuervain's syndrome is good. Many patients can recover after rest or physical therapy, few people with DeQuervain's syndrome need surgery.

Possible complications
Hand and wrist movements gets limited on a longer run to avoid pain from untreated de Quervain's tenosynovitis. Lack of movement leads to more pain and less strength and flexibility. Eventually, the range of motion gets severely restricted.

Source
http://rarediseases.info.nih.gov/GARD/Condition/9413/De_Quervains_disease.aspx