De Quervain's Disease Research Articles

Raktamokshana - A Customary Perspective to alleviate De Quervain’s Tenosynovitis w.s.r. to Vatarakta - A Rare Case Study

The discovery of De Quervain's Tenosynovitis was much acknowledged in classical books in terms of symptoms that could be associated to Vatarakta (Gout), but the disease's nomenclature was only identified in the later period of global modernization. This case study describes a young woman who was pre-diagnosed with De Quervain's condition and treated using the Vatarakta paradigm of treatment protocols, principally raktamokshana (Blood-letting). Raktamokshana with the advent of jalauka (leech) is taken into consideration in the study because Vata and Rakta (blood) are vitiated, which furthers the disease. Rakatamokshana is an excellent treatment option for De Quervain's Tenosynovitis due to its efficiency, simplicity of administration, and safe therapy regimen. With outstanding results for pain management and the restoration of the functioning of the wrist joint, this therapy modality can therefore be recommended for the condition. Need of study: To evaluate the new conceptual idea for treating De Quervain’s Tenosynovitis that is non-invasive and helps to restoring the normal function of corresponding hand and wrist movements. Methodology: Current case report presents a 34-year-old woman with a right-hand dominant job whose primary complaints were pain, morning stiffness, localized burning sensation and swelling at the radial styloid process on the right hand at the base of the thumb for the past two months, who was diagnosed as De Quervain’s Tenosynovitis and was treated with Raktamokshana with Jaluka with two sittings. Conclusion: After first sitting she had 80% relief from symptoms and was totally symptomless after second sitting of Raktamokshana, helping new therapeutic regimen to treat the disease.

Surgical Treatment of De Quervain's Tenosynovitis: A Literature Review

De Quervain's tenosynovitis is a common condition that affects the tendons of the thumb at the wrist. In this literature review article, a comprehensive overview of the surgical treatment of this disease is presented. Aspects related to epidemiology, clinical significance, definition, diagnosis, surgical techniques and indications, complications are addressed and a discussion on the results and effectiveness of treatment is offered. Based on the available evidence, it is concluded that surgical treatment of de Quervain's tenosynovitis is an effective and safe option in selected cases that do not respond to conservative measures.

Treatment selection for de Quervain's tenosynovitis based on the Michigan’s Hand Questionnaire

Objective: De Quervain's disease is a stenosing tenosynovitis of the first dorsal compartment. Treatment options include conservative measures, injections, and surgery. The main purpose of this study is to eliminate uncertainty in the choice of treatment and to recommend the appropriate treatment to the patient based on Michigan hand questionnaire. 
 Material and Methods: The age, sex, and treatment modality of the patients were recorded retrospectively. Patients' Michigan outcomes were assessed, and patients were divided into three groups: Patients who benefited from conservative treatments (Group 1), from injections (Group 2), and from surgery (Group 3). Statistical analysis of the data was performed.
 Results: The mean age of the 56 patients (54 women, 2 men) was 35.1±11.4 years. There was a difference between all groups in total hand function and pain scores (p < 0.05). Patients in group 1 were significantly different from the other groups (p < 0.05), and there was no significant difference between group 2 and group 3 (p > 0.05).
 Conclusion: Various methods have been described for De Quervain's tenosynovitis’s treatment. Choosing the right therapeutic steps for the right patients is important. It is possible to select treatment options by assessing overall hand function and activities of daily living with the Michigan Hand Outcome Questionnaire

De Quervain Tenosynovitis as a Risk Factor of New-Onset Adhesive Capsulitis: A Nationwide Cohort Study.

This study investigated the association of de Quervain tenosynovitis (DQT) with subsequent adhesive capsulitis (AC) development. Patients with DQT between 2001 and 2017 from the Taiwan National Health Insurance Research Database were the DQT cohort. The 1:1 propensity score matching method was applied for creating control cohort. The primary outcome was defined as new-onset of AC at least 1 year after the date of confirmed diagnosis of DQT. In total, 32,048 patients with mean age 45.3 years were included. DQT was significantly positively associated with risk of new-onset AC after adjustment for baseline characteristics. Furthermore, severe DQT requiring rehabilitation was positively associated with risk of new-onset AC. In addition, male gender and age under 40 may be additional risk factors for new-onset AC, compared to female gender and age over 40. Cumulative incidence of AC after 17 years was 24.1% among patients with severe DQT requiring rehabilitation and was 20.8% among patients with DQT without rehabilitation. This is the first population-based study to demonstrate an association between DQT and new-onset AC. The findings recommend that preventive occupational therapy, including active modification for the shoulder joint and adjustments to daily activities, may be necessary for patients with DQT to reduce their risk of developing AC.

A Rare Case of Carpal Tunnel Syndrome in a Teacher

A case of carpal tunnel syndrome was incidentally discovered during an occupational pathology consultation in a 51-year-old class teacher, with more than 24 years of service, presenting with tingling and tingling in the right hand and pain radiating to fingers and forearm. The use of chalk on the blackboard and the pen on paper constituted the professional causes found. The symptomatology was exacerbated after each working day, calmed down during weekends and holidays, and awoke to rare domestic work such as (washing linen, sifting flour, etc.). The patient, after numerous consultations in traumatology for joint pain in the wrist, was also followed by another doctor for arterial hypertension. The result of the first ultrasound was contradictory to the clinic, concluding with De Quervain's tendonitis. The CT scan of the wrist did not provide any evidence for the diagnosis. The requested electromyogram was not made available. The infiltration of corticosteroids helped to calm the pain and the associated signs.

Endoscopy assisted surgical treatment of De Quervain tenosynovitis

Endoscopy assisted surgical treatment of De Quervain tenosynovitis

Development of de Quervain Tenosynovitis After Distal Radius Fracture.

We sought to determine the risk factors for the development of de Quervain tenosynovitis after distal radius fractures. Our hypothesis is that longer periods of immobilization and higher-energy fracture patterns will correlate with the development of de Quervain tenosynovitis. This is a 10-year retrospective study of 1451 consecutive patients with distal radius fractures presenting to a large academic institution. The incidence and relative risk of de Quervain tenosynovitis within 1 year of sustaining a distal radius fracture were analyzed. In total, 41 patients developed posttraumatic de Quervain tenosynovitis at an average time of 6.5 months. In the operative cohort, the incidence was 2.2%, and that of the nonoperative group was 3.8%. Among all affected patients, 78% admitted to strenuous, overuse activities or careers. Compared with the unaffected cohort, the de Quervain tenosynovitis group was more likely to be female and black with similar age and body mass index. The traumatic cohort was less likely to respond to corticosteroid injections. A separate extensor pollicis brevis (EPB) sheath was noted in all patients requiring surgical release. Patients with a nonoperative distal radius fracture were 4.2 times more likely to develop de Quervain's than the general population, and those treated operatively were 2.4 times more likely. These patients were more likely to be female, black, and engage in strenuous overuse activities or careers. They demonstrated higher-energy fracture patterns and worse response to corticosteroid injections, more frequently requiring surgical decompression. Among those requiring surgery, patients were 2.5 times more likely to have a separate EPB sheath than those with atraumatic Quervain's.

Prevalence of DeQuervain’s Tenosynovitis among Clinical Physical Therapists in Islamabad: A cross-sectional study

Aims: To determine the prevalence of De Quervain’s tenosynovitis among clinical physical therapists in Islamabad. Study design: A descriptive cross-sectional study Place and duration: We conducted this study among clinical physical therapists working in hospitals and clinics of Rawalpindi and Islamabad from Feb 2022 to Aug 2022. Methods: We included 288 clinical physical therapists that were selected through non-probability quota sampling. Both male and female clinical physical therapists with ages ranging from 25 to 50 yrs having thumb pain, with one year of clinical experience who worked for 4 to 8 hours per day at least 4 days a week were included in the study. The De Quervain tenosynovitis was diagnosed in participants having tenderness at the base of the thumb and a positive Finkelstein test. A positive Finkelstein sign indicates pain over the region of the abductor pollicis and extensor pollicis tendon. The data were collected and statistically analyzed using SPSS version 26. Results were shown in the form of frequency tables and graphs. Results: Out of 288 participants, 77(26.73%) had tenderness at the base of the thumb and 77(26.74%) clinician physical therapists had positive Finkelstein test. This indicates that 26.73% had De Quervain’s Tenosynovitis. Out of them, 31.94% of cases were males and 21.51% were females. Out of these 77 therapists, 4(5.2%) therapists suffered from mild pain, 61 (79.2%) physical therapists experienced moderate pain while 12(15.6%) therapists with positive cases had severe thumb pain. Conclusions: The study concluded that there was a prevalence of De Quervain’s tenosynovitis among clinical physiotherapists experiencing thumb pain. Key words: De Quervain’s tenosynovitis, Physical Therapists, Finkelstein’s test, Thumb pain

TO DETERMINE EFFECTIVENESS OF SURGICAL RELEASE IN MANAGEMENT OF DE QUERVAIN'S TENOSYNOVITIS

Introduction: De Quervain tenosynovitis is rst described by Fritz de Quervain, in 1895. It involves tendon entrapment of the rst dorsal compartment of the wrist and thickening of the tendon sheaths of rst dorsal compartment the abductor pollicis longus and extensor pollicis brevis, where the tendons pass through the bro-osseous tunnel located along the radial styloid at the distal wrist. Pain is exacerbated by thumb movement and radial or ulnar deviation of the wrist. The prevalence of de Quervain tenosynovitis is about 0.5% in men and 1.3% in women with peak prevalence in their fourth and fth decades of life respectively. The present Materials and Methods: study was a prospective study. This Study was conducted from December 2021 to December 2022 at Department of Rampurhat Government Medical College and Hospital, West Bengal, India. In the total of 20 patients Result: were included, out of which 16 patients are female and 4 patients are male. Surgical release has excellent outcome; splinti Conclusion: ng and local steroid injection can be an alternative treatment option for DQ disease especially in patients with low grade disease.

CASE REPORT : DE QUERVAIN'S SYNDROME “SPECIALISTIC COMPETENCY THAT IS EASILY DIAGNOSED BY GENERAL PRACTITIONERS”

De Quervain syndrome is an inflammation of tendon sheath in synovial sheath covering extensor pollicis brevis and abductor pollicis longus accompanied with pain. Diagnosis can be made by general practitioner based on patient’s history, clinical findings and proper maneuver. The aim of this study is to describe the specialist competencies that can be diagnosed by general practitioners using specific examinations.
 Keywords : De Quervain syndrome, diagnosis, maneuver

De Quervain's Disease: A Discourse on Etiology, Diagnosis, and Treatment.

Since Fritz De Quervain first postulated stenosing tenosynovitis within the radial dorsum of the wrist, much research has been conducted to provide further insights. De Quervain's Disease (DQD) is a condition that affects the tendons that control the movement of the thumb, specifically the abductor pollicis longus and extensor pollicis brevis. Numerous studies have shown that structural divergence from normal anatomy is partly related to contingency for developing DQD. Even though this condition was discovered many years ago, its exact etiology remains a subject of debate. Two schools of thought exist, one that contends an inflammatory-mediated pathway and the other degenerative changes. Substantial evidence exists for both theories, thus necessitating further studies into the etiology of DQD. Classically, Finkelstein's and Eichhoff's tests have been used as the physical examinations of choice for clinically diagnosing this condition. However, these tests have been shown to have low specificity, hence, the emergence of the wrist hyperflexion and abduction of the thumb test. Evidence also suggests that ultrasonography may become a critical diagnostic tool, especially to identify anatomical variations before invasive treatment, reducing the risk of further complications. The management of DQD is typically conservative, with escalation to steroid injections before surgery is indicated. Future research into this disease should focus on establishing a clearer picture of how anatomical variations and other pathological and occupational factors may interplay to bring about this condition. While current research has suggested possible novel approaches for diagnosing and treating DQD, more studies are required to gain greater insights into the effectiveness of these interventions.

Anatomical Variations of the First Dorsal Compartment in de Quervain Tenosynovitis.

De Quervain tenosynovitis of the wrist is a common pathology. The primary aim of this study is to determine the prevalence of extensor pollicis brevis and abductor pollicis longus (APL) anatomical variations in association with de Quervain tenosynovitis. The secondary aim was to compare additional patient-specific factors associated with de Quervain tenosynovitis. This retrospective study included 172 patients with de Quervain tenosynovitis who underwent first dorsal compartment release and 179 patients with thumb carpometacarpal (CMC) arthritis who underwent thumb CMC arthroplasty between August 1, 2007, and May 1, 2022. The CMC group was chosen as the control group because the study surgeons perform APL suspensionplasty as the primary procedure for thumb CMC arthritis, allowing for a comparison group without de Quervain tenosynovitis. Exclusion criteria included patients undergoing revision surgery, patients undergoing thumb CMC procedure other than APL suspensionplasty, and patients with both CMC and first dorsal compartment diagnoses. Demographics, clinical variables, and intraoperative findings were collected through retrospective chart reviews. Patients in the de Quervain tenosynovitis group tended to be younger (51 years, range: 23-92 years vs 63 years, range: 28-85 years), women (86.1% vs 77.1%), and more commonly of African American or black race (15.7% vs 3.9%) and Asian race (5.2% vs 0%). There was a higher prevalence of tendon subcompartments (79.1% vs 64.2%), but fewer number of APL slips (38.3% vs 20.7% 2 or fewer slips) seen in the de Quervain tenosynovitis group. Anatomical variation exists between patients with and without de Quervain tenosynovitis. The presence of tendon subcompartments but not an increased number of tendon slips is associated with de Quervain tenosynovitis.

Comparison of the Effect of Intralesional Injection of Corticosteroid and Platelet-rich Plasma in Patients with de Quervain’s Tenosynovitis

Background: De Querveins’ tenosynovitis affects the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment of the wrist. Corticosteroid injection is the mainstay of treatment for those patients who do not respond to conservative management. Platelet-rich plasma (PRP) is a currently used strategy in the clinical practice to provide a regenerative stimulus for tendon healing. Objective: To evaluate the effects of Platelet-rich plasma in the treatment of DQVD in comparison with corticosteroid (CS) injection. Materials and Methods: The present randomized clinical trial had been conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka. A total of 100 patients with pain and swelling over the radial aspect of the wrist with positive Finkelstein test were randomly allocated into three groups: group A (received platelet-rich plasma injection), group B (received corticosteroid injection) and group C (received conservative management). The severity of pain and functional status of the wrist joint were recorded according to VAS and Mayo’s wrist score both pre-procedurally on day 0 and post-procedurally at the end of 1st, 3rd and 6th month. Results: The mean age of the participants in group A, B and C were 45.6 (±10.4), 46.9 (±11.3) and 42.4 (±6.3) years respectively. In all groups, majority of the study participants were female and housewives. No significant statistical difference was observed among the groups regarding VAS scores and Mayo’s Wrist Scores at baseline. At the end of 6 months, the reduction of pain in group A was significantly lower than group B (p<0.001). Again, at the end of 6 months, the improvement of Mayo’s Wrist Scores in group A group was significantly higher than group B (p<0.001). In group A, 77.8% reduction of pain score was achieved while in group B, 68.4%reduction of pain score was achieved after 6 month of treatment (p<0.001). Conclusions: Platelet-rich plasma provides better functional outcome than corticosteroid in the treatment of de Quervain tenosynovitis. Bangladesh Medical Res Counc Bull 2023; 49(1): 32-38

Effect of radiofrequency in de Quervain's tenosynovitis: A randomized control trial

Background. De Quervain's tenosynovitis is mucoid degeneration of the tendon sheaths of the two tendons that regulate the mobility of the thumb. As a result, the wrist's thumb side is painful and uncomfortable. Objectives. To assess radiofrequency's effectiveness in patients with de Quervain’s tenosynovitis. Design. A prospective randomized controlled trial. Setting. physical therapy department, Rail Way Hospital. Methods. 40 participants with de Quervain’s tenosynovitis. Participants were divided into two groups at random: group A (control group), which received an ultrasound, transverse friction massage, and strengthening exercises; and group B (study group), which received radiofrequency plus ultrasound, transverse friction massage, and strengthening exercises. Pain intensity, hand grip strength, and pinch strength were all measured at the baseline and after 4 weeks of treatment by using the visual analog scale, Jamar dynamometer, and pinch gauge, respectively. Results. All outcome indicators in both groups improved statistically significantly (P < 0.05), according to within-group comparisons. The between-group comparisons showed significant improvement in all outcome measures for both groups (P < 0.05), with the study group showing superior improvement to the control group; the study group's VAS improvement percentage was 28.7%, its grip strength improvement percentage was 6.71%, and its pinch strength improvement percentage was 28.6%. Conclusion. In comparison to ultrasound, transverse friction massage, and strengthen exercise, radiofrequency plus ultrasound, transverse friction massage, and strengthen exercise resulted in greater improvements in de Quervain's tenosynovitis patients' pain intensity, hand grip strength, and pinch strength.

First extensor compartment morphology and clinical significance: a cadaver series study.

The first extensor compartment of the wrist is a distinctly variable anatomical area. Anatomical variations in this region contribute to the pathophysiology and treatment failure of de Quervain's disease, which is a kind of tenosynovitis that develops in the first extensor compartment of the wrist. We aim to describe the first extensor compartment morphology, to evaluate the septum frequency, location of the septum, and the number of tendons of abductor pollicis longus (APL) and extensor pollicis brevis muscles (EPB). First extensor compartment of 87 wrists of 45 cadavers were dissected. The presence or absence of septum and number of tendon slips of APL and EPB revealed. The proximal and distal widths of the compartments were measured. Septums were detected in 60.9% (n=53) of the wrists. Incomplete (distal) and complete (proximal) septa were present in 35.6% (n=31) and 25.3% (n=22) of the cases. Only 26.4% of the wrists had a single slip of APL tendon. The Remaining had multiple slips. The median inner width of the proximal and distal compartments in all wrists were calculated as in the order of 9.11±1.14 mm and 8.55±1.12 mm. We believe that understanding the anatomy of the first extensor compartment in the Turkish population would be helpful to surgeons, radiologists, and physiotherapists to diagnose and manage de Quervain's disease.

Short-term Effectiveness of High-intensity Laser Therapy in De Quervain Tenosynovitis: A Prospective, Randomized, Controlled Study.

The effectiveness of high-intensity laser therapy (HILT) has been demonstrated in some musculoskeletal repetitive strain injury disorders. This study aimed to determine the short-term effectiveness of HILT in de Quervain tenosynovitis (DQT). Sixty-four patients with DQT diagnosis (32 males, 32 females; 18-65 years) were randomly divided into two groups. A short opponens splint was applied to both groups and HILT to the treatment group and sham HILT to the control group once a day, on alternate days, 3 days a week, for 5 weeks. Pre- and post-treatment evaluations were made using a visual analog scale (VAS); Quick Disabilities of the Arm, Shoulder, and Hand questionnaire; Short Form-36 Health Survey; and hand grip strength test. The demographic results (age, gender, duration of complaint, body mass index, occupational group) of both groups were similar (p>0.05). The pre-treatment measured values were similar in both groups (p>0.05). After a 5-week treatment, a significant improvement was observed in all parameters in both groups. Post-treatment, hand grip strength levels were statistically higher in the HILT group than in the sham therapy group, and VAS levels were significantly lower (p<0.001). HILT is a non-invasive and reliable method that increases grip strength and decreases pain in DQT.

Symptoms, Diagnosis, and Treatments of Stenosing Tenosynovitis

Sports injuries frequently occur to the hand and wrist, and one of the most common illnesses of the hand and wrist is stenosing tenosynovitis. This report concentrated on stenosing tenosynovitis, encompassing hand and wrist anatomy, high-risk groups and activities, diagnosis, conservative treatment, surgery, traditional Chinese treatment, and post-operative precautions. A high prevalence of stenosing tenosynovitis has been linked to specific sports, occupations, lifestyles, genes, illnesses, and females. The most noticeable clinical symptom is a brief blocking of the fingers during flexion, followed by painful snapping during extension. Auxiliary apparatus such as MRI, ultrasound, and goniometer, as well as specific testing for De Quervain tenosynovitis, are the two basic commonly used diagnostic techniques. Conservative treatment, surgery, and traditional Chinese medicine are options for treating stenosing tenosynovitis. Conservative treatment includes orthoses, steroid injections, and NSAIDs. Surgery involves open release and percutaneous procedures, and the major modalities of Chinese medicine are acupuncture and moxibustion, needle knives and massage. After being successfully treated, the prognosis findings could be influenced by lifestyle, psychological changes, environment, and exercise.

Clinical examination of the hand

Clinical examination of the hand requires a structured approach allowing the clinician the formulate an appropriate differential diagnosis for the purposes of further investigation and timely diagnosis and management. Eliciting a careful history and subsequently employing the examination principles of inspection, palpation, and movement, followed by targeted special tests, are key to assessing the various pathologies affecting the hand. This article discusses the key elements of history-taking and examination structure when assessing hand pathology, and reviews in detail the special tests involved in common pathology seen in the hand, including osteoarthritis, rheumatoid arthritis, carpal tunnel syndrome, cubital tunnel syndrome, Dupuytren's disease, and de Quervain's tenosynovitis.

Effect of Therapeutic Ultrasound and Deep Friction Massage in De-Quervain’s Tenosynovitis

Objective: To determine the effectiveness of ultrasound therapy and deep friction massage in relieving symptoms of de-quervain’s tenosynovitis Material and methods: This Study Was Conducted In Physiotherapy Department Of Al-Shafi Medical Rehabilitation Complex. It is a Randomized controlled trial. There were 2 groups consisting of 20 patients each (patients with de-qurvain’s tenosynovitis). The data was collected through the following data collection tools. Hand assessment tool (hat). Visual analogue scale (vas). Results: Mean score of Hand Assessment Tool between both groups was -0.550 Std. 0.152 with a P-value of 0.001. Mean score of Visual Analog Score mean difference between both groups was -0.350 Std. 0.205 with a P-value of 0.097. Practical Implication: Postoperatively, the wrist is splinted in a neutral position until the skin sutures are removed. This will minimize the probability of tendon anterior subluxation Conclusion: Ultrasound therapy is effective in treating de-quervain’s tenosynovitis. Deep friction massage is also effective in treating de-quervain’s tenosynovitis. Keywords: Ultrasound therapy, Deep Friction Massage, de Quervain's tenosynovitis, neutral position, Pakistan

Preferred treatment approach to De Quervain Tenosynovitis in nursing women: conservative management or surgery?

We aimed to show the effectiveness of different treatment methods in the prevention of clinical symptoms and recurrence of De Quervain Tenosynovitis (DQT), which is often seen in nursing women. Three different treatment methods were used in 124 patients, all of whom were breastfeeding women who visited our clinic between 2017-2022 with a positive Finkelstein test and DQT. Group I comprised 56 patients who underwent surgical treatment under local anesthesia, Group II, 41 patients who received steroid injections as conservative treatment, and Group III, 27 patients who received wrist splints. The patient files of all groups were reviewed retrospectively, and the effects of the treatment methods on clinical symptoms and recurrence were investigated in patients who were followed up at the 2nd, 4th and 8th weeks. The recurrence rate of Group I patients, which were treated surgically, was significantly lower than that of Group II and III (p=0.0001). Among those who received conservative treatment, patients in Group II had significantly lower recurrence rates than those in Group III. At the 8th week of treatment, clinical symptoms had improved by 96.45%, 58.5%, and 7.4% in Groups I, II, and III, respectively. It is thought that the repetitive movements made during baby care and the edema that develops in breastfeeding women prepare the ground for DQT. Surgery is the most effective treatment method for the improvement of clinical symptoms and prevention of recurrence.