De Quervain's tendonitis and osteopathy
What is De Quervain's tendonitis?
De Quervain's tendonitis, also known as De Quervain's tenosynovitis, was described by the Swiss surgeon Frederic de Quervain in 1895.
De Quervain's tendonitis corresponds to tenosynovitis of the long abductor and the short extensor of the thumb. It affects many people and this pathology is frequent in pregnant women.
Anatomical reminders:
The long abductor of the thumb
Insertion:
- The middle part of the posterior surface of the radius
- The upper lateral part of the posterior surface of the ulna
- The interosseous membrane.
Path: It goes down and out
Termination:
- Base of the lateral tubercle of the 1st metacarpal
- Trapeziometacarpal capsule of I
- Expansion at the level of the abductor brevis of the I
Role:
- Stabilization of the trapeziometacarpal
- Thumb abduction
Innervation: Deep branch of the radial nerve (C7-C8)
Vascularization: Posterior interosseous artery
Extensor digitorum brevis
Insertion:
- Middle 1/3 of the posterior surface of the raidus under the abductor longus of the I
- On the posterior aspect of the ulna under the abductor longus I (inconsistent).
Path: It goes down and out
Termination: Tendon on the dorsal surface of the base of the first phalanx of the I.
Roles:
- Stabilization of the metacarpophalangeal joint
- Extension of the metacarpophalangeal joint of the thumb
Innervation: Deep branch of the radial nerve (C7-C8)
Vascularization: Posterior interosseous artery
Who is affected by De Quervain's tendonitis?
This pathology affected in the past the washerwomen, it was even called "disease of the washerwomen". Nowadays, it mainly affects nurses and seamstresses. But it also affects those who start gardening too intensively and not progressively.
De Quervain's tendonitis mainly affects women between 40 and 50 years old.
Physiopathology of De Quervain's tendonitis
De Quervain's tendonitis occurs when there is a conflict between the tendon of the long abductor and/or the short extensor and/or their sheaths. The tendon slides poorly in its sheath and a fibrous stenosis develops.
Symptoms of De Quervain's tenosynovitis:
- Pain located on the outer edge of the wrist
- Swelling on the outer edge of the wrist
- Pain reproduced with the Finkelstein test.
- Pain with progressive onset (a few weeks) most often but in some cases can occur suddenly
- Pain triggered by thumb movement
- Possible radiation in the forearm
- Adduction against resistance of the thumb reproduces the pain
What tests should be done?
Ultrasound is the examination of choice. It will show thickening of the tendon and a fluid layer around the tendons of the extensor pollicis brevis and abductor pollicis longus.
Treatment of De Quervain's tendonitis
Eviction of the cause and rest
The first phase of treatment consists of resting the thumb and stopping the original movement when possible. Resting is beneficial.
Lifting blockages: osteopathy ++.
The second step consists of removing all the blockages that maintain the dysfunctions. For example, in the case of De Quervain's tendonitis, there is often a blockage of the trapezius-metacarpal joint of the thumb. Your osteopath's role will be to treat the area but also the repercussions that this may have had on the forearm.
Strapping or kinesiotaping
Consult a trained osteopath or another professional trained in kinesiotaping and strapping. Depending on the injury, your caregiver will prefer one or the other. This is a good alternative to splinting which can be disabling.
Infiltrations
In advanced or recalcitrant cases, infiltrations can be considered.
Surgery ?
In very rare cases, surgery is performed to allow the tendons to slide perfectly. An immobilization of 3 weeks with a splint generally follows this intervention.
Marie Messager
Osteopath D.O
2 rue Alexis de Tocqueville
78000 Versailles
