De Quervain Tenosynovitis: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment

Introduction 

The dorsal compartment of the wrist is made of tendons of two muscles – extensor pollicis brevis and abductor pollicis longus. The tendons are covered by a synovial sheath. Synovium is a connective tissue that lines the inner aspect of a joint capsule. This synovial sheath separates the first dorsal compartment from the remaining dorsal compartments of the wrist. The tendons travel through the fibrous tunnel, which is 2 cm, under the extensor retinaculum and over the radial styloid. During their passage, the tendons may become entrapped especially in the setting of repetitive motion or acute trauma. This is referred to as De Quervain tenosynovitis. [1]

What is De Quervain Tenosynovitis?

De Quervain tenosynovitis is characterized by the entrapment of the tendons in the first dorsal compartment in the wrist. In this condition, the tendon sheaths surrounding the two muscle tendons thicken as the tendons travel through the fibro-osseous tunnel. Ulnar deviation of the wrist, radial deviation of the wrist, and thumb movements may exacerbate the pain at the wrist. [1]

Symptoms of De Quervain Tenosynovitis 

The symptoms of De Quervain tenosynovitis are as follows. [1]

  1. Wrist pain at the radial aspect of the wrist 
  2. The wrist pain is worsened upon thumb and wrist motion
  3. Pain while performing tasks that involve holding objects, turning the wrist, and grasping objects 
  4. Difficulty with tasks including opening jar lids
  5. Tenderness over the radial styloid 
  6. Fusiform swelling over the radial styloid 
  7. Swelling of the tendon
  8. Pain in the thumb
  9. Catching or snapping of the thumb
  10. Provocative Finkelstein test that involves flexion of the thumb and deviation of the wrist 

Causes and Risk Factors of De Quervain Tenosynovitis 

The causes and risk factors associated with the development of De Quervain tenosynovitis are as follows. [1]

  1. Overuse activities at the wrist joint such as pinching, gripping, and grasping
  2. Direct injury of the tendons present in the first dorsal compartment in the wrist 
  3. Diseases such as rheumatoid arthritis contribute to the development of De Quervain tenosynovitis 
  4. Individuals with ages 30-50 years are at an increased risk for De Quervain tenosynovitis 
  5. Pregnancy 
  6. Mothers of newborns 
  7. Certain jobs and hobbies are associated with the onset of De Quervain tenosynovitis 

Normal Healing Cycle 

The normal healing cycle comprises three key stages. These include the inflammatory stage, proliferation stage, and lastly the maturation stage that reflects the resolution of the healing cycle. The description of each stage of the healing cycle is given as follows. [2]

  1. The first stage of the normal healing cycle is inflammation. During this stage, the inflammatory cells at the site of injury release substances such as cytokines and inflammatory mediators. The inflammatory mediators cause the immune cells to arrive at the site of injury and combat the causative agent of inflammation. The cardinal signs of inflammation are pain, warmth, swelling, redness, and loss of function at the affected site. 
  2. The second stage of the normal healing cycle in proliferation. During this stage, the proliferative fibroblasts deposit collagen, new blood vessels form by a process known as angiogenesis, the extracellular matrix is synthesized, and re-epithelization occurs. 
  3. The third stage of the normal healing cycle is maturation, during which scar formation and wound contraction occur. During this stage, type I collagen substitutes for type III collagen present in the scar tissue. This stage marks the completion of the healing cycle.

Chromic Conditions and Healing Cycle 

Chronic inflammation is long-term inflammation that lasts from several months to even years. In chronic inflammation, the healing cycle fails to resolve and oscillates between the proliferative and inflammatory stages. Chronic inflammation is also characterized by the development of fascia restrictions, excessive scar tissue, formation of muscle trigger points, and muscle spasm. [3]

Ineffective Treatments 

There are various approaches to the treatment of De Quervain tenosynovitis and alleviation of pain. However, these common and traditional therapeutic approaches either provide temporary pain relief or exacerbate the damage. These therapeutic approaches are mentioned as follows. 

  1. Application of heat and ice 
  2. Electrical stimulation of the wrist 
  3. Massage therapy and use of a foam roller
  4. Stretching of the wrist 
  5. Strength exercises during the inflammation stage of the healing cycle
  6. Mobilization of the wrist and thumb

Effective Treatments of De Quervain Tenosynovitis 

Effective treatments of De Quervain tenosynovitis include the avoidance of triggers that elicit pain such as repetitive motions, resolution of the inflammation stage, and the resolution of the proliferation stage. The strategies for resolving the inflammation and proliferation stage for achieving the completion of the healing cycle are as follows. 

  1. The resolution of the inflammation stage of the healing cycle in De Quervain tenosynovitis involves the following strategies.
    1. Adequate rest at the wrist and avoidance of repetitive movement of the wrist and thumb.
    2. Restoration of vitamin and mineral deficiencies for promoting the resolution of the inflammation phase. The AskASTR program is useful for the recognition of nutrient deficiencies. The software also recommends nutrient supplements to counter nutrient deficiencies.
    3. MagnaHeal device made of neodymium and anti-inflammatory substances can also be used for the resolution of the inflammation stage.  MagnaHeal 1 with a magnetic force length of 2 inches is useful for the resolution of mild inflammation. MagnaHeal 2 with a magnetic force length of 3 inches is useful for the resolution of severe inflammation.  [4] 
    4. The consumption of an anti-inflammatory diet is also useful for the resolution of the inflammation stage of the healing cycle in De Quervain tenosynovitis. This diet consists of fish, whole grains, vegetables, fruits, and unsaturated fats. [5]
  2. The mechanisms involved in the resolution of the proliferation stage of the healing cycle in De Quervain tenosynovitis are as follows.
    1. Superficial and aponeurotic fascia restrictions are released using the A1 Tool.
    2. Superficial scar tissue and superficial muscle trigger points are released using the A3 Tool.
    3. Deep scar tissue as well as epimysium, perimysium, and endomysium fascia restrictions are released using the A5 Tool.  

Conclusion 

The management of De Quervain tenosynovitis and the associated pain involves the resolution of the proliferation and inflammation stages of the healing cycle along with the avoidance of repetitive behaviors that elicit and aggravate the pain. 

References 

  1. Satteson E, Tannan SC. De Quervain Tenosynovitis. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442005/ 
  2. Ozgok Kangal MK, Regan JP. Wound Healing. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535406/ 
  3. Pahwa, R., Goyal, A., & Jialal, I. (2022). Chronic Inflammation. In StatPearls. StatPearls Publishing.
  4. Ross, C. L., & Harrison, B. S. (2013). Effect of pulsed electromagnetic field on inflammatory pathway markers in RAW 264.7 murine macrophages. Journal of inflammation research6, 45–51. https://doi.org/10.2147/JIR.S40269
  5. Dragan, S., Șerban, M. C., Damian, G., Buleu, F., Valcovici, M., & Christodorescu, R. (2020). Dietary Patterns and Interventions to Alleviate Chronic Pain. Nutrients12(9), 2510. https://doi.org/10.3390/nu12092510