De Quervain's Tenosynovitis

This is a common condition that affects the tendons that are used to straighten (extend) your thumb. The most common causes are overuse of the affected tendons and wrist trauma. Rest of the affected tendons may be all that is required in some cases. Other treatments include pain relief, physiotherapy and steroid injections. If these measures fail surgical release is possible.

Assessment

Signs and Symptoms

The typical symptom is pain over your wrist at the base of your thumb that is made worse by activity and eased by rest.

  • De Quervain's is a tenosynovitis affecting the abductor pollicis longus and extensor pollicis brevis tendons which form the anterior border of the anatomical snuffbox. The tendons normally share a single sheath
  • Often obvious precipitating factor e.g. mother repeatedly carrying new baby
  • +ve Finkelstein's test – place thumb within hand and bend the hand into ulnar deviation; pain is experienced in the region of the radial styloid process

Management

Treatment options are

Conservative management by:

  • Advise the patient to avoid activities that cause pain, if possible.
  • Advise the patient to use a wrist/thumb splint. It needs to immoblise the thumb as well as the wrist.
  • Advise non-steroidal anti-inflamatories (NSAIDs), systemic or topical (see 10.1 Rheumatic diseases and gout)

If symptoms persist for more than a month, offer steroid injection (see 6.3.2 Glucocorticoid therapy), which may relieve the pain in about 70% of cases.

If symptoms persist after 6 weeks, review diagnosis / consider a second injection.

Symptoms persisting beyond four months and failed conservative management consider surgery.

Referral

Referral Criteria

Symptoms persisting beyond four months despite conservative management including a maximum of two steroid injections, refer for surgery.

Referral Instructions

Refer to the Hand Clinic (Orthopaedics/Plastics) using the e-Referral Service

  • Specialty: Orthopaedics
  • Clinic Type: Hand and Wrist
  • Service: DRSS-South Devon & Torbay-Orthopaedics-Hand & Wrist-Devon CCG - 15N

Referral Forms

DRSS Referral Form

Torbay and South Devon seeking advice form

Supporting Information

Patient Information

British Society for Surgery of the Hand

Pathway Group

This guideline has been signed off on behalf of the South Devon & Torbay CCG.

Publication date: March 2017

 

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