Yes, i now have a gimp left hand (get your obscene jokes out of the way now). I went to a specialist last week, and then to a hand therapist today to get a custom splint made to start my treatment for my arm disorder. I have 4-6 weeks of wearing a splint as much as possible to get he inflammation of the wrist tendons down, take a bunch of antiinflamatory drugs and work on therapy to build strength up in my left wrist. Fun stuff I tell you. At least im getting it done and caught it early enough that it should be no problem. Combine this with going to the dentist later this week and meeting a new general practice doctor tomorrow, im up to my ass in doctors right now. Heres wikipedia's definition of my syndrome.
DeQuervain tenosynovitis
de Quervain syndrome (also known as washerwoman's
sprain, Radial
styloid tenosynovitis, de Quervain disease, de Quervain's
tenosynovitis, de Quervain's stenosing
tenosynovitis or mother's wrist), is an
inflammation or a tendinosis of the sheath or tunnel that surrounds two
tendons that control movement of the
thumb Eponym
It is named after the
Swiss surgeon Fritz de Quervain who first identified it in 1895.
[2] It should not be confused with "
de Quervain's thyroiditis", another condition named for the same person.
Pathology
The mucous sheaths of the tendons on the back of the wrist.
The two tendons concerned are the tendons of the
extensor pollicis brevis and
abductor pollicis longus muscles. These two muscles, which run side by side, have almost the same function: the movement of the thumb away from the hand in the plane of the hand--so called radial abduction (as opposed to movement of the thumb away from the hand, out of the plane of the hand (palmar abduction)). The tendons run, as do all of the tendons passing the wrist, in
synovial sheaths, which contain them and allow them to exercise their function whatever the position of the wrist. While de Quervain syndrome is commonly believed to be an inflammatory condition or tendosynovitis, evaluation of histological specimens shows no inflammatory changes--rather a thickening and myxoid degeneration consistent with a chronic degenerative process are seen.
[3] The pathology is identical in de Quervain seen in new mothers.
[4]de Quervain syndrome is more common in women. A speculative rationale for this is that women have a greater
styloid process angle of the radius, but scientific support for this theory is lacking.
[
edit] Cause
The cause of de Quervain's disease is not known. In medical terms, it remains
idiopathic.
Some claim that this diagnosis should be included among
overuse injuries and that repetitive movements of the thumb are a contributing factor. More specifically, repetitive eccentric lowering of the wrist into ulnar deviation especially with a load in the hand such as a child or even a stack of dishes.
de Quervain's syndrome was also referred to as mother's wrist due to the fact that it can be caused by over-extending the wrist into the awkward positions that parents use to hold and handle infants. It was also nicknamed washerwoman's sprain as it can be caused by wringing motions, such as wringing out a washrag or similarly, removing the lid from a jar.
Recently cases have surfaced linked to the use of video game controlers with a so called "Analog-stick".
[
edit] Symptoms
This article may contain
original research or
unverified claims. Please
improve the article by adding
references. See the
talk page for details. (October 2008)
Symptoms are pain, tenderness, and swelling over the thumb side of the wrist, and difficulty gripping.
Finkelstein's test is used to diagnose de Quervain syndrome in people who have wrist pain. To perform the test, the thumb is placed in the closed fist and the hand is tilted towards the little finger - ulna deviation (as in the picture) in order to test for pain at the wrist below the thumb. Pain can occur in the normal individual, but if severe, DeQuervain's syndrome is likely. Pain will be located on the thumb side of the forearm about an in inch below the wrist.
Differential diagnosis includes ruling out:
Osteoarthritis of the first carpo-metacarpal joint
Intersection syndrome - pain will be more towards the middle of the back of the forearm and about 2-3 inches below the wrist
Wartenberg's syndrome[
edit] Treatment
The management of De Quervain’s disease is determined more by convention than scientific data. From the original description of the illness in 1895 until the first description of corticosteroid injection by Christie in 1955
[7], it appears that the only treatment offered was surgery.
[8] [9][10] Since approximately 1972 the prevailing opinion has been that of McKenzie (1972) who suggested that corticosteroid injection was the first line of treatment and surgery should be reserved for unsuccessful injections.
[11] However, data regarding the efficacy of corticosteroid injection is sparse and uncontrolled (Oxford Level of Evidence 4) and it is not clear that there is a benefit over the natural history of the illness. A structured review published in 2003 identified only 35 publications that addressed De Quervain’s on Medline, only 7 of which presented data regarding corticosteroid injection, and none of which were controlled studies.
[12]Retrospective studies all report success rates for corticosteroid injection greater than 70%, but the one prospective cohort study noted a success rate of only 58% and many of those patients took 12 to 18 months until symptom resolution.
[13] While the authors of that study ascribed the failure of corticosteroid injection to anatomical variations, it has not been clearly established that corticosteroid injection is better than placebo or that a symptom course of 12 to 18 months is any better than the natural course of the illness.
Another commonly used criterion for failure of non-operative treatment is election of operative treatment, but the decision to operate is complex and biased by the beliefs and emotions of the surgeon and the patient. Use of an elective event such as surgery to define success makes data regarding nonoperative treatment difficult to interpret. For instance, in one of the two investigations in which a substantial number of patients were treated without injection (splints and anti-inflammatory medication alone were used), a remarkable 45 of 93 (48%) of patients in all non-operative treatment groups had surgery.
[14] This may simply reflect frustration on the part of both the patient and the surgeon with the prolonged symptom course associated with the disease. It may appear to both patient and surgeon that, after many months of symptoms, the illness will never resolve. The data of Lane and colleagues
[15] indicating that non-operative treatment is successful only in mild cases is similarly marred by the lack of patients randomly assigned to alternative treatments and the use in many patients of a decision for surgery as a failure criterion.
Most tendinoses are self-limiting and the same is likely to be true of de Quervain's although further study is needed.
Palliative treatments include a splint that immobilized the wrist and the thumb to the interphalangeal joint and anti-inflammatory medication or acetaminophen.
Surgery (in which the sheath of the first dorsal compartment is opened longitudinally) is documented to provide relief in most patients.
[16] The most important risk is to the radial sensory nerve.
