Orthopedics - Oleksa A.P. 2006

Pathophysiology of Joints
Developmental Defects and Congenital Skeletal Anomalies
De Quervain's Disease

In the literature, this condition is known as tenosynovitis stenosans extensoris brevis et abductoris longi pollicis, or stenosing tenosynovitis of the extensor pollicis brevis and abductor pollicis longus tendons (Fig. 81).

The condition is typically caused by the overuse of the thumb Muscles during activities that require force while the thumb is abducted (such as chopping wood, cutting with scissors by tailors, wringing out laundry, etc.).

Constant friction of the tendon sheaths of the extensor pollicis brevis and abductor pollicis longus muscles leads to edema and inflammation along these tendons, most frequently localized in the region of the radial styloid process.

Abduction and extension of the thumb cause pain, which distinguishes this condition from tenosynovitis carpi, where pain occurs during palmar flexion.

Pathological changes involve inflammation and secondary thickening of the tendon sheaths, alongside degenerative alterations within the tendons themselves. This impairs or even completely prevents the smooth gliding of the tendons within their sheaths due to pain. Occasionally, finger movement may produce a palpable characteristic crepitus over the tendon trajectory.

Because the radial styloid process lies in close proximity to these tendons, it may undergo secondary pathological changes. In chronic cases, radiographs can reveal osteoporotic changes and even destruction of the styloid process. Furthermore, P. Karawanów (1965) observed indistinct shadows in the adjacent soft Tissues.

Treatment. In the early stages, immobilization of the thumb is of paramount importance. Therefore, the plaster cast should immobilize the thumb, including the distal phalanx, and extend to the middle third of the forearm.

Local administration of hydrocortisone or Kenalog-40 diluted with novocaine and an antibiotic, administered prior to applying the cast, is beneficial. UHF therapy can be administered without removing the cast. Two weeks later, the cast is removed and thumb function is assessed. When treatment is initiated promptly, outcomes are generally favorable.

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Fig. 81. De Quervain's disease (localization of tenosynovitis affecting the extensor Muscle of the thumb).

In advanced cases, characterized by tenosynovitis with significant thickening of the sheath, treatment takes longer and outcomes are often less satisfactory. Such cases require surgical intervention, which is performed under anesthesia. The tendon sheaths of the extensor pollicis brevis and abductor pollicis longus are exposed by an incision in the tissues over the distal articular end of the radius along the projected path of the tendons. The thickened sheath, which restricts tendon gliding, is longitudinally incised, and thumb mobility is subsequently tested. If necessary, the sheaths of both tendons are opened. The wound is then sutured. Active thumb movements are initiated on the 5th to 6th day, and following suture removal, a comprehensive rehabilitation program is prescribed (therapeutic exercise, physical and balneotherapy, ronidase or lidase Electrophoresis, etc.).