Quervain Syndrome


Alessandro Moccia
Rome, Italy

De Quervain Syndrome

Is a stenosing tenosynovitis of the tendons of the long abductor and of the short extensor of the thumb as they pass through the radial styloid process at the level of the first dorsal extensor compartment. The two affected tendons run very close to each other and form one of the margins of the fossa visible at the root of the thumb, known as the ‘anatomical snuffbox’ as it once served snuff users. The condition is more common among women than among men; it appears between the ages of 30 and 50 and the dominant hand is often affected, as this is the one most frequently used in work and play in movements or positions that promote onset of the condition.

It is encountered among people who carry out repeated pincer movements with the thumb or who spend long periods with their wrist in a flexed position. This syndrome has also been called ‘mouse disease’ as changes in wrist direction – especially if the elbow is unsupported – induce inflammation in the abductor pollicis longus and the extensor pollicis brevis within their shared synovial sheath. The pathology also occurs frequently among sports enthusiasts. Tennis players, golfers, fencers, etc., expose this tendinous area to repeated stress over time. These movements stretch the tendons concerned, causing inflammation, which, if permitted to persist, leads to a reduction in sliding space available, promoting the thickening and stenosis of the synovial sheath of the first extensor retinaculum compartment. This leads to onset of pain above the styloid process of the radius, which, in a worst case scenario, radiates proximally to the forearm and distally to the thumb. The pain, exacerbated by use of the hand, intensifies and may sometimes lead to considerable disability (e.g. difficulty in carrying out simple movements such as turning a key in a stiff lock).

Objectively, an edematous area is found and upon palpation marked hyperesthesia above the styloid process is noted; it is also possible to perceive crepitation along the tendon sheath. Diagnosis of this pathology is conducted by means of the Fikelstein test. The patient is asked to hold their thumb close against the palm and to ulnar deviate the wrist. If positive, pain is felt in the styloid region and in the first extensor compartment.

Treatment consists first and foremost in suspending activities that might promote inflammation and in the application of ice several times a day. Effective rehabilitation measures are manual therapies and lower intensity diathermy. However, the use of Neuromuscular Taping is essential. Application consists in a small double fan on the affected tendons, which cross at the point of the anatomical snuffbox. This has the purpose of vascularization and drainage of the phlogistic process.

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