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De Quervain syndrome

De Quervain syndrome, is a tenosynovitis of the sheath or tunnel that


de Quervain Syndrome
surrounds two tendons that control movement of thethumb.[1]
Synonyms BlackBerry thumb, texting
thumb, gamer's thumb,
washerwoman's sprain, radial
styloid tenosynovitis, de
Contents
Quervain disease, de
1 Signs and symptoms Quervain's tenosynovitis, de
2 Causes Quervain's stenosing
3 Pathophysiology
4 Diagnosis
5 Treatment
6 Eponym
7 Society and culture
8 See also
9 References
10 External links

Signs and symptoms


Finkelstein's test for DeQuervain's tenosynovitis
Symptoms are pain at the radial side of the wrist, spasms, tenderness,
Pronunciation French pronunciation:[də kɛʁvɛ̃]
occasional burning sensation in the hand, and swelling over the thumb
side of the wrist, and difficulty gripping with the affected side of the Classification and external resources
hand. The onset is often gradual.[1] Pain is made worse by movement Specialty rheumatology
[1]
of the thumb and wrist, and may radiate to the thumb or the forearm.
ICD-10 M65.4
ICD-9-CM 727.04
Causes
DiseasesDB 3472
The cause of de Quervain's disease is not established. Evidence
eMedicine pmr/36
regarding a possible relation with occupational risk factors is
MeSH D053684
debated.[2][3] A systematic review of potential risk factors discussed in
the literature did not find any evidence of a causal relationship with
occupational factors.[4] However, researchers in France found personal and work-
related factors were associated with de Quervain's disease in the working population;
wrist bending and movements associated with the twisting or driving of screws were
the most significant of the work-related factors.[5] Proponents of the view that De
Quervain syndrome is a repetitive strain injury[6] consider postures where the thumb
is held in abduction and extension to be predisposing factors.[2] Workers who
perform rapid repetitive activities involving pinching, grasping, pulling or pushing
have been considered at increased risk.[3] Specific activities that have been
Young people using their
postulated as potential risk factors include intensive computer mouse use, trackball
smartphones with their thumbs.
use,[2] and typing, as well as some pastimes, including bowling, golf, fly-fishing,
piano-playing, sewing, and knitting.[3]
Women are affected more often than men.[3] The syndrome commonly occurs during and after pregnancy.[7] Contributory factors
[7][8]
may include hormonal changes, fluid retention and—more debatably—lifting.

Pathophysiology
De Quervain syndrome involves noninflammatory thickening of the tendons and the
synovial sheaths that the tendons run through. The two tendons concerned are those
of the extensor pollicis brevis and abductor pollicis longus muscles. These two
muscles run side by side and function to bring the thumb away from the hand; the
extensor pollicis brevis brings the thumb outwards radially, and the abductor pollicis
longus brings the thumb forward away from the palm. De Quervain tendinopathy
affects the tendons of these muscles as they pass from the forearm into the hand via
a fibro-osseous tunnel (the first dorsal compartment). Evaluation of
histopathological specimens shows a thickening and myxoid degeneration consistent
with a chronic degenerative process, as opposed to inflammation.[9] The pathology
is identical in de Quervain seen in new mothers.[10]

Diagnosis
De Quervain syndrome is diagnosed clinically, based on history and physical
examination, though diagnostic imaging such as x-ray may be used to rule out
fracture, arthritis, or other causes, based on the patient's history and presentation.
The mucous sheaths of the tendons
Finkelstein's test is a physical exam maneuver used to diagnose de Quervain
on the back of the wrist.
syndrome. To perform the test, the examiner grasps the thumb and sharply deviates
the hand toward the ulnar side. If sharp pain occurs along the distal radius (top of
forearm, about an inch below the wrist), de Quervain's syndrome is likely. While a positive Finkelstein's test is often considered
osteoarthritis at the base of the thumb.[1]
pathognomonic for de Quervain syndrome, the maneuver can also cause pain in those with

Differential diagnoses[11] include:

1. Osteoarthritis of the first carpo-metacarpal joint


2. Intersection syndrome—pain will be more towards the middle of the back of the forearm and about 2–3 inches below
the wrist
3. Wartenberg's syndrome

Treatment
As with many musculoskeletal conditions, the management of de Quervain's disease is determined more by convention than scientific
data. From the original description of the illness in 1895 until the first description of corticosteroid injection by Jarrod Ismond in
1955,[12] it appears that the only treatment offered was surgery.[12][13][14] Since approximately 1972, the prevailing opinion has been
that of McKenzie (1972) who suggested that corticosteroid injection was the first line of treatment and surgery should be reserved for
unsuccessful injections.[15] A systematic review and meta-analysis published in 2013 found that corticosteroid injection seems to be
an effective form of conservative management of de Quervain's syndrome in approximately 50% of patients, although more research
is needed regarding the extent of any clinical benefits.[16] Efficacy data are relatively sparse and it is not clear whether benefits affect
the overall natural history of the illness.

Most tendinoses are self-limiting and the same is likely to be true of de Quervain's although further study is needed.

Palliative treatments include a splint that immobilized the wrist and the thumb to the interphalangeal joint and anti-inflammatory
[17][18]
medication or acetaminophen. Systematic review and meta-analysis do not support the use of splinting over steroid injections.
Surgery (in which the sheath of the first dorsal compartment is opened longitudinally) is documented to provide relief in most
patients.[19] The most important risk is to the radial sensory nerve.

Some physical and occupational therapists suggest alternative lifting mechanics based on the debatable theory that the condition is
due to repetitive use of the thumbs during lifting such as seen in new mothers picking up their child. Physical/Occupational therapy
can suggest activities to avoid based on the theory that certain activities might exacerbate one's condition, as well as instruct on
strengthening exercises based on the theory that this will contribute to better form and use of other muscle groups, which might limit
( catastrophizing) and kinesiophobia.[20]
irritation of the tendons. This approach may risk reinforcing catastrophic thinkingpain

Some physical and occupational therapists use other treatments based on the rationale that they reduce inflammation and pain and
promote healing: UST, SWD, or other deep heat treatments, as well as TENS, acupuncture, or infrared light therapy, and cold laser
treatments. However, the pathology of the condition is not inflammatory changes to the synovial sheath and inflammation is
secondary to the condition from friction.[21] Teaching patients to reduce their secondary inflammation does not treat the underlying
condition but may reduce their pain.

Eponym
It is named after the Swiss surgeon Fritz de Quervain who first identified it in 1895.[22] It should not be confused with de Quervain's
thyroiditis, another condition named after the same person.

Society and culture


BlackBerry thumb is a neologism that refers to a form of repetitive strain injury (RSI) caused by the frequent use of the thumbs to
press buttons on PDAs, smartphones, or other mobile devices. The name of the condition comes from the BlackBerry, a brand of
smartphone that debuted in 1999,[23] although there are numerous other similareponymous conditions that exist such as "Wiiitis",[24]
"Nintendinitis",[25] "Playstation thumb", "texting thumb",[26] "cellphone thumb",[27] "smartphone thumb", "Android thumb", and
"iPhone thumb". The medical name for the condition is De Quervain syndrome and is associated with the tendons connected to the
thumb through the wrist. Causes for the condition extend beyond smartphones and gaming consoles to include activities like golf,
racket sports, and lifting.[28]

Symptoms of BlackBerry thumb include aching and throbbing pain in the thumb and wrist.[29] In severe cases, it can lead to
temporary disability of the affected hand, particularly the ability to grip objects.[30]

One hypothesis is that the thumb does not have the dexterity the other four fingers have and is therefore not well-suited to high speed
touch typing.[31]

See also
Mobile phone overuse
Nomophobia

References
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ookup?view=long&pmid=18063716). J Am Acad Orthop Surg. 15 (12): 757–64. PMID 18063716 (https://www.ncbi.nl
m.nih.gov/pubmed/18063716).
2. Andréu JL, Otón T, Silva-Fernández L, SanzJ (February 2011). "Hand pain other than carpal tunnel syndrome
(CTS): the role of occupational factors".Best Pract Res Clin Rheumatol. 25 (1): 31–42. PMID 21663848 (https://ww
w.ncbi.nlm.nih.gov/pubmed/21663848). doi:10.1016/j.berh.2010.12.001(https://doi.org/10.1016%2Fj.berh.2010.12.0
01).
3. O'Neill, Carina J (2008). "de Quervain T
enosynovitis". In Frontera, Walter R; Siver, Julie K; Rizzo, Thomas D.
Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation (https://book
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4007-1. Retrieved 9 August 2013.
4. Stahl, Stéphane; Vida, Daniel; Meisner, Christoph; Lotter, Oliver; Rothenberger, Jens; Schaller, Hans-Eberhard;
Stahl, Adelana Santos (December 2013). "Systematic Review and Meta-Analysis on the oWrk-Related Cause of de
Quervain Tenosynovitis". Plastic and Reconstructive Surgery. 132 (6): 1479–1491. PMID 24005369 (https://www.ncb
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434409.32594.1b).
5. "Risk factors for de Quervain's disease in a French working population".
Scand J Work Environ Health. 37 (5): 394–
401. Sep 2011. doi:10.5271/sjweh.3160 (https://doi.org/10.5271%2Fsjweh.3160).
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303661_Repetitive_strain_injury/file/d912f50c5ef67d0b27.pdf)(PDF). Lancet. 369 (9575): 1815–22.
PMID 17531890 (https://www.ncbi.nlm.nih.gov/pubmed/17531890). doi:10.1016/S0140-6736(07)60820-4(https://doi.
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Leppert, Phyllis Carolyn; Peipert, Jeffrey F. Primary Care for Women(https://books.google.com/books?id=PiiD0iUNhl
IC&pg=PA664). Lippincott Williams & Wilkins. p. 664.ISBN 978-0-7817-3790-6. Retrieved 9 August 2013.
8. http://www.assh.org/Public/HandConditions/Pages/deQuervainsTendonitis.aspx
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doi:10.1136/bmj.1.4929.1501(https://doi.org/10.1136%2Fbmj.1.4929.1501) .
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(6): 832–41.
15. McKenzie JM (Dec 1972). "Conservative treatment of de Quervain's disease".
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doi:10.1136/bmj.4.5841.659(https://doi.org/10.1136%2Fbmj.4.5841.659).
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nosynovitis/DS00692). Mayo Clinic. Retrieved 2012-12-05.
29. Joyce, Amy (23 April 2005)."For Some, Thumb Pain Is BlackBerry's Stain"(https://www.washingtonpost.com/wp-dy
n/content/article/2005/04/22/AR2005042201739.html)
. The Washington Post. Retrieved 2010-04-03.
30. "The Agony of 'BlackBerry Thumb'" (https://web.archive.org/web/20100419052633/http://www .wired.com/science/dis
coveries/news/2005/10/69294). Wired.com. 21 October 2005. Archived fromthe original (https://www.wired.com/scie
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31. "BlackBerry Thumb: Real Illness or Just Dumb?"(http://arthritis.webmd.com/news/20050126/BlackBerry-thumb-real-i
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External links
DeQuervain's Syndrome: Medical Imagery - Medical Art and Illustration
The Sports Medicine Patient Advisor: De Quervain's eTnosynovitis Rehabilitation Exercises
De Quervains Tenosynovitis: Symptoms andTreatments

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