Quervain’s Tenosynovitis

The condition called de quervains tenosynovitis causes pain on the inside of the wrist and forearm just above the thump.

• It is the inflammation of the fluid filled sheath that surrounds a tendon
• This is the common problem effecting the wrist and usually easy to diagnose
• Tendons connect muscle to the born and the muscles pull on tendons for movements.
• The muscles connected to anterior posterior ligaments and extensor pollicis brevis tendons are on the back of the forearm.
• APL & EPB (Refer above for the abbrev) tendons travel inside edge of the wrist.
• They pass through a tunnel near the end of the forearm.
• This tunnel is lined with a slippery coating called tenosynovium
• The inflammation of the tenosynovium and tendon is called tenosynovitis
• In this condition the inflammation constricts the movement of the tendons within the tunnel.

Causes:

• Repeated thump motions such as  grasping, pinching, squeezing
• Arthritis or injury
• Introduction of bacteria into a sheath through a small penetrating wound such as that made by the point of needle or thorn.

Symptoms:

• Soreness of thumb , side of the forearm and near the wrist.
• The two tendons may move through the constricted tunnel. These causes noise while moving hand called crepitus.
• Pain and swelling
• Difficulty in moving joint.

Diagnosis:

Flnklestein test

• Bend your thumb into your palm
• Grasp the thumb with in your fingers making a fist.
• Bend your wrist away from your thumb
• If you feel pain over the tendons to the thumb the test is positive.

Physical examination shows swelling

Stretching tendon to check whether there is pain.

Treatments:

1. Stop all activities that causes your symptoms
2. Take break when doing repeated hand and thumb movements
3. Avoid grasping , wringing or turning and twisting movements of the wrist.
4. After injury is evaluated wear a special forearm and thumb splint called a thumb – spica spint.
5. Use Anti inflammation drugs
6. Stretching and strengthening exercise to wrist and forearm.