De Quervain's tendovaginitis

Dr. med. Mira Seidel is a freelance writer for the medical team.

More about the experts All content is checked by medical journalists.

Tendovaginitis de Quervain (Quervain's disease, housewife's thumb) is tendinitis in the area of ​​the first tendon compartment on the wrist. The cause is overuse of the thumb. Pain is typical, especially on the wrist below the thumb. The treatment is initially conservative. If the pain recurs, surgery can be considered. You can find everything you need to know about de Quervain's tendovaginitis here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M65

Tendovaginitis de Quervain: description

The Swiss surgeon Fritz de Quervain was the first to describe the tendinitis in 1895, which is now known as Tendovaginitis de Quervain (more precisely: Tendovaginitis stenosans de Quervain). It affects the first of a total of six tendon compartments on the back of the hand. Two tendons run through this tendon compartment: the tendons of the short extensor pollicis brevis and the abductor pollicis longus.

In a healthy state, both tendons slide smoothly through the tendon compartment, surrounded by lubricating fluid. If the tendons are injured by trauma or excessively stressed by recurring loads, the tendon compartment can swell. The tendons are narrowed. To make matters worse, the first tendon compartment is sometimes still subdivided, i.e. a small septum (septum) runs between the two tendons, which means that the space for is already reduced.

Tendovaginitis de Quervain is also known colloquially as the “housewife's thumb” because women are eight times more likely to be affected than men. It occurs more frequently after the age of 40.

Tendovaginitis de Quervain: symptoms

Typical symptoms that suggest de Quervain's tendovaginitis are pain in the wrist below the thumb. Particularly when holding and grasping firmly, severe pain occurs at the level of the stylus extension of the spoke (processus styloideus radii), which radiate into the thumb. Any movement of the thumb can cause pain. For example, wringing out a towel can be very painful. The affected area is also swollen.

If de Quervain's tendovaginitis is very pronounced, those affected usually describe palpable and audible rubbing. In the later stage, the tendons can be completely blocked and no longer flexed at all. Most of the time, the symptoms often last for several weeks or even months. Patients often report that the wrist and hand were heavily strained or overloaded before the symptoms occurred.

De Quervain's tendovaginitis: causes and risk factors

Tendovaginitis de Quervain can be caused by excessive strain with repeated extension and removal movements of the thumb and sideways movements of the wrist. Bending the hand for a long time can also narrow the extensor tendons of the thumb and squeeze them off. A classic example is, for example, mothers who carry their child in their arms and support them with their hands. The tendons are then pressed against the edge of the retinaculum (a tight band around the wrist), causing them to become irritated and eventually swell.

In many cases, however, the cause of de Quervain's tendovaginitis remains unclear.

Tendovaginitis de Quervain: examinations and diagnosis

In addition to local soft tissue swelling and tenderness, various tests can be used in the clinical examination. The so-called Finkelstein test is characteristic of de Quervain's tendovaginitis.

Tendovaginitis de Quervain: Finkelstein test

The Finkelstein's sign can be used as a clinical test to diagnose de Quervain's tendovaginitis. The fist is formed around the thumb of the affected hand. Then, with your fist closed, you quickly tilt the wrist towards the tip of the thumb (towards the ulnar). If this triggers violent electrifying pain, this indicates de Quervain's tendovaginitis.

Tendovaginitis de Quervain: Imaging Techniques

Further diagnostic steps such as an X-ray examination are generally not necessary. However, the X-ray can be useful in some cases if you want to rule out mechanical blockage in the joint. Otherwise, in unclear cases, an ultrasound examination (sonography) can clearly show the tendons and the surrounding structures.

Tendovaginitis de Quervain: treatment

De Quervain's tendovaginitis is initially treated conservatively. This is especially true in the early stages, when the symptoms are not yet as pronounced. It is particularly important to avoid activities that cause pain, especially movements that involve bending the hand to the side of the thumb. To do this, the thumb can be immobilized in a plaster cast. To combat inflammation, local anti-inflammatory drugs can be applied as an ointment.

If this does not improve the symptoms of Quervain's tendovaginitis, the patient is given anti-inflammatory cortisone injections (usually together with a local anesthetic). However, caution is advised because the injections can damage the tendons.

If the pain recurs and cortisone therapy is unsuccessful, surgery is usually recommended. It can be carried out on an outpatient basis. In order for the surgeon to see the nerves, tendons and other structures better, the procedure is carried out in a bloodless state. That means: The patient is given a pressure cuff on the upper arm to restrict the blood supply to the forearm. Then a small skin incision is made lengthways over the affected extensor tendon compartment. The first extensor tendon compartment is then split. If there is an additional septum between the tendons, this is also cut. Before the surgeon sutures up the wound, he checks that the tendons can now slide freely.

Finally, a compression bandage is applied to the wrist and forearm. After about a week, the patient can begin lighter activities. About three weeks after the procedure, the hand and wrist are usually able to bear normal loads again.

Tendovaginitis de Quervain: disease course and prognosis

As a result of the operation, the symptoms of de Quervain's tendovaginitis improve rapidly in most cases: the pain disappears and mobility is restored.

Tags:  medicinal herbal home remedies Menstruation gpp