The incision is minimal and the approach releases the first dorsal compartment, allowing the tendons to have unfettered access through this area. If the symptoms persist in spite of nonoperative management, surgery may be indicated this surgery may be performed as an outpatient basis and typically utilizes local anesthetic. ![]() Adverse reactions with steroids are unlikely but include infection, tendon rupture, and depigmentationĪ steroid injection of the left hand first dorsal compartment for Dequervains Surgical Treatment If symptoms recur, a second injection is less likely to alleviate symptoms. Injections of steroid into the compartment to decrease swelling of the synovium results in alleviation of symptoms in approximately 50% of patients. Similarly, although oral anti-inflammatory medication (Motrin, Aleve) have theoretical good utilizations-they are seldom effective except in mild cases. However, studies have questioned the efficacy of bracing and now many surgeons do not utilize bracing. Traditionally, bracing was utilized to decrease use of the area. Non-Surgical Treatmentĭecreasing the swelling of the tendon sheath (tenosynovium) may be addressed by several entities. This test stretches the tendons of the first dorsal compartment and patients who have De Quervain’s tendonitis will find this test painful with pain radiating from the thumb into the mid forearmĪll treatment for this condition is centered on relieving the pressure in the first dorsal compartment which is causing pain. To perform a Finkelstein test, the patients thumb is placed into the palm and the wrist is bent downward. Tenderness to palpation over the first dorsal compartment must be differentiated from wrist pain-typically over the anatomic snuff box (scaphoid).įinkelstein devised a physical test for this condition and it carries his name to this date. The range of motion of the fingers and thumb are checked, along with the wrist. Often patients complain of pain with bumping this area and may be confused as to whether wrist or thumb motion aggravates the Hand Surgeon ExaminationĪfter your surgeon has taken a history, the next step is a physical examination. The pain is typically activity related and may be accompanied by swelling. Patients present to a hand surgeon with complaints of pain on the inside portion of the wrist. It also is associated with pregnancy and rheumatoid disease. Patients with this variation may have an increased risk of developing De Quervain’s tendonitis.Ī right hand showing the thumb tendons running through the first dorsal compartmentĭe Quervain’s tendinosis may be caused by overuse. Often there is a separate fibrous sub sheath which houses the abductor pollicis brevis. Typically there are multiple slips to the abductor pollicis longus. The first compartment contains the tendons for the abductor pollicis longus and the abductor pollicis brevis. The sheath are numbered from the inside portion of the wrist to the outside portion of the wrist. These sheaths resembled electrical conduits and contain the tendons within their boundary. The tendons on the top of the hand are contained within strong fibrous sheaths which are termed compartments. Unlike the tendons on the bottom of the wrist, the tendons in this area are enclosed in a tight sheath-predisposing this area to difficulty. Tendonitis along the inside portion of the wrist was first described by De Quervain, a European surgeon. A Patient’s Guide to De Quervain’s Tendinosis (Tendonitis at the Wrist) Introduction
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