De Quervain syndrome

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De Quervain syndrome is a two-tendon inflammation that controls the movement of the thumb and the tendon sheath. This causes pain on the outside of the wrist. Pain usually increases by grasping or twisting the wrist. The thumb may also be difficult to move smoothly. The onset of symptoms gradually.

Risk factors include certain repetitive movements, pregnancy, trauma, and rheumatic diseases. Diagnosis is generally based on symptoms and physical examination. This is supported if the pain increases when the wrist is bent inward when someone holds their thumb in the fist.

Treatment involves avoiding activities that carry symptoms, pain medications such as NSAIDs, and thumb splints. If this is not recommended, steroid injections or effective surgery may be recommended. This condition affects about 0.5% of men and 1.3% of women. Those who are middle-aged are most often affected. This was first described in 1895 by Fritz de Quervain.

Video De Quervain syndrome

Signs and symptoms

Symptoms are pain on the radial side of the wrist, seizures, tenderness, occasional burning sensation in the hand, and swelling over the thumb side of the wrist, and difficulty gripping the affected side of the hand. The onset is often gradual. The pain is exacerbated by the movement of the thumb and wrist, and can spread to the thumb or forearm.

Maps De Quervain syndrome

Cause

The cause of de Quervain's disease is unknown. Evidence of possible relationships with occupational risk factors is debated. A systematic review of the potential risk factors discussed in the literature found no evidence of causal relationships with occupational factors. However, researchers in France found personal and work-related factors associated with de Quervain's disease in the working population; Wrist bending and movement associated with rotating or driving screws are the most significant of the work-related factors. Proponents of the view that De Quervain syndrome is a recurrent strain injury that takes into consideration the posture in which the thumb is retained during abduction and extension becomes a predisposing factor. Workers who engage in recurrent activities that involve pinching, grasping, pulling or pushing have been considered at increased risk. Specific activities that have been postulated as potential risk factors include intensive computer mouse usage, trackball usage, and typing, as well as some entertainment, including bowling, golf, fishing, piano playing, sewing, and knitting.

Women are more often affected than men. This syndrome generally occurs during and after pregnancy. Contribute factors may include hormonal changes, fluid retention and - more debatable - lifting.

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Pathophysiology

De Quervain's syndrome involves thickening of the incomplete tendon and the synovial sheath through which the tendon passes. Both tendons are extensor pollicis brevis and abductor pollicis longus. Both of these muscles run side by side and serve to bring the thumb away from the hand; extensor pollicis brevis brings the thumb out radically, and the abductor pollicis longus brings the thumb forward from the palm of the hand. De Quervain tendinopathy affects the tendons of these muscles as they move from the forearm to the hand through the fibro-osseous tunnel (the first dorsal compartment). Evaluation of histopathologic specimens showed both thickening and myxoid degeneration consistent with chronic degenerative processes, compared with inflammation. This pathology is identical in de Quervain seen in the new mother.

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Diagnosis

De Quervain syndrome is clinically diagnosed, based on history and physical examination, although diagnostic imaging such as x-rays may be used to rule out fracture, arthritis, or other causes, based on a person's history and presentation. Eichoff's modified maneuver, commonly called the Finkelstein test, is a physical examination maneuver used to diagnose Quervain syndrome. To perform the test, the tester catches and the ulnar deviates hands when the person has his thumb held on to their fists. If sharp pain occurs along the distal radius (the upper part of the forearm, about an inch below the wrist), possible de Quervain syndrome. While positive Finkelstein tests are often considered pathognomonic for de Quervain's syndrome, maneuvers can also cause pain in those with osteoarthritis at the base of the thumb.

Differential diagnosis

The differential diagnosis includes:

1. Osteoarthritis of the first carpo-metacarpal joint
2. Intersection syndrome - pain will be more toward the middle of the back of the forearm and about 2-3 inches below the wrist
3. Wartenberg's Syndrome

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Treatment

Like many musculoskeletal conditions, de Quervain's disease management is more determined by conventions than on scientific data. A systematic review and meta-analysis published in 2013 found that corticosteroid injection appears to be an effective form of conservative de Quervain syndrome management in about 50% of patients, although further research is needed on the extent of clinical benefit. The efficacy data is relatively rare and it is not clear whether the benefits affect the overall natural history of the disease.

Most tendinoses are self-limiting and the same is likely in de Quervain, although further research is needed.

Palliative care includes splints that paralyze the wrist and thumb to the interphalangeal joint and anti-inflammatory drugs or acetaminophen. Systematic review and meta-analysis do not support the use of splinting through steroid injections.

Surgery (in which the first dorsal compartment sheath is opened longitudinally) is documented to provide relief to most patients. The most important risk is the radial sensory nerve.

Some occupational and physical occupational therapists suggest alternative lifting mechanics based on the theory that this condition is due to repeated use of the thumb during lifting. Physical/Occupational Therapy can suggest activities to be avoided based on the theory that certain activities can aggravate a person's condition, and instruct on strengthening exercises based on the theory that this will contribute to the formation and use of better muscle groups, which can limit irritation. of the tendon.

Some occupational and physical therapists use other treatments, in conjunction with Therapeutic Exercise, on the grounds that they reduce inflammation and pain and promote healing: UST, SWD, or other internal heat treatments, as well as TENS, acupuncture, or infrared light therapy. , and cold laser treatment. However, the pathology of this condition is not a change of inflammation in the synovial cover and inflammation secondary to the condition of friction. Teaching patients to reduce their secondary inflammation does not treat the underlying conditions but can reduce their pain; which is very helpful when trying to do a defined exercise intervention.

Getting Physical Therapies before surgery or injections has been shown to reduce overall costs for patients and is a viable option for treating various musculoskeletal injuries.

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History

From the original description of the disease in 1895 to the first description of corticosteroid injection by Jarrod Ismond in 1955, it appears that the only treatment offered was surgery. Since about 1972, the prevailing opinion is that McKenzie (1972) suggested that corticosteroid injections are first-line treatment and surgery should be provided for unsuccessful injections.

Eponyms

It was named after Swiss surgeon Fritz de Quervain who first identified it in 1895. It should not be confused with de Quervain's thyroiditis, another condition named for the same person.

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Society and culture

BlackBerry thumb is a neologism that refers to a form of repetitive strain injury (RSI) caused by the frequent use of the thumb to push a button on a PDA, smartphone, or other mobile device. The name of this condition comes from BlackBerry, a smartphone brand that debuted in 1999, although there are many other similar conditions such as "Wiiitis", "Nintendinitis", "Playstation thumb", "texting thumb", "thumb phone" thumb smartphone "," Android thumbs up ", and" iPhone thumbs up ". The medical name for this condition is De Quervain's syndrome and is associated with a tendon that connects to the thumb through the wrist. The cause for this condition goes beyond smartphones and game consoles to include activities like golf, racquet sports, and lifting.

Symptoms of BlackBerry thumb include sore aches and aches in the thumb and wrist. In severe cases, it can cause temporary hand defects affected, especially the ability to hold objects.

One hypothesis is that the thumb does not have the dexterity possessed by the other four fingers and is therefore unsuitable for typing high-speed touch.

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See also

• The phone is overused
• Nomophobia

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References

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External links

Source of the article : Wikipedia