It is an inflammation of the thumb tendons (extensor pollicis brevis and abductor pollicis brevis) located on the external side of the wrist. It is related to the excessive and repeated friction between these tendons and the sheath where they slide on the external edge of the wrist. In patients suffering from this pathology, the sheath is too narrow by anatomical predisposition, thus maintaining the tendon inflammation and making the patient enter a vicious circle.

Who is affected by this condition?

This infection mainly affects women, most often after the age of 50. Repetitive and frequent movements of the thumb and in particular of the thumb-index clamp favors the appearance of the tendinitis, in particular among seamstresses, mechanics, physiotherapists, secretaries. De Quervain's tendinopathy can therefore constitute an occupational disease (table 57B of occupational diseases).

What are the symptoms of tenosynovitis?

Pain is the main reason for consultation. It is located at the external edge of the wrist and appears progressively over a few weeks, considerably hindering thumb movements. The intensity of the pain is very variable from one individual to another, it can sometimes become sleepless and very disabling with painful radiations to the forearm. A painful swelling is frequently found on palpation opposite the outer edge of the wrist. It corresponds to the thickening of the tendon sheath in conflict with the tendons.

The Finkelstein maneuver is a characteristic test for this tendinopathy. It consists in triggering pain when the thumb is moved towards the ring finger with an ulnar tilt of the wrist. This maneuver puts tension on the inflammatory tendons.

How is the diagnosis made?

This is essentially a clinical diagnosis. In case of diagnostic doubt, an ultrasound may be performed and will confirm the inflammation of the tendons surrounding the short extensor and long abductor tendons of the thumb.

How is De Quervain's Tendinopathy treated?

Treatment is primarily medical because, if properly carried out, it leads to a cure in 80% of cases. It must combine :

- A resting of the thumb by stopping the activities that promote
            tendinopathy.

- Oral and local anti-inflammatory drugs

- A resting brace at night

For cases resistant to these treatments, infiltrative treatment with corticosteroids may be useful.

The night orthosis must be kept on for a total of three months. In case of professional origin, it is important that the resumption of work is done with an adaptation of the workstation.

Surgical treatment is reserved for forms that are resistant to well-managed medical treatment and for painful recurrences. It is performed under loco-regional anesthesia of the upper limb and on an outpatient basis (the patient does not sleep in the clinic). Through a minimally invasive approach performed at the outer edge of the wrist, the tendon sheath is opened in order to decompress the tendons, and the peri-tendinous synovial inflammation is removed.

Specific rehabilitation is started in the week following the operation. On average, six weeks are necessary for the pain to disappear completely. For manual workers, a work stoppage of the same duration is most often necessary.

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