FACTOID # 28: Austin, Texas has more people than Alaska.
 
 Home   Encyclopedia   Statistics   States A-Z   Flags   Maps   FAQ   About 
   
 
WHAT'S NEW
 

SEARCH ALL

FACTS & STATISTICS    Advanced view

Search encyclopedia, statistics and forums:

 

 

(* = Graphable)

 

 


Encyclopedia > DeQuervain's syndrome
DeQuervain's Syndrome
Classification & external resources
Finkelstein's test for DeQuervain's tenosynovitis
ICD-10 M65.4
ICD-9 727.04
eMedicine pmr/36 

DeQuervain's syndrome (also known as washerwoman's sprain, Radial styloid tenosynovitis, De Quervain's disease or mother's wrist), named for Swiss surgeon Fritz de Quervain who first identified it in 1885, is an inflammation of the sheath or tunnel that surrounds two tendons that control movement of the thumb. Image File history File links Metadata Size of this preview: 800 × 600 pixelsFull resolution (2048 × 1536 pixel, file size: 561 KB, MIME type: image/jpeg) I shot this photo and release all rights I, the copyright holder of this work, hereby release it into the public domain. ... Finkelsteins test for DeQuervains tenosynovitis Finkelsteins test is used to diagnose DeQuervains tenosynovitis in people who have wrist pain. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // M00-M99 - Diseases of the musculoskeletal system and connective tissue (M00-M25) Arthropathies (M00-M03) Infectious arthropathies (M00) Pyogenic arthritis (M01) Direct infections of joint in infectious and parasitic diseases classified elsewhere (M02) Reactive arthropathies (M023) Reiters disease (M03) Postinfective and reactive arthropathies in diseases classified elsewhere (M05-M14... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... A sprain (from the French espraindre - to wring) is an injury which occurs to ligaments caused by a sudden over stretching (for the muscle injury, see strain). ... In anatomy, a styloid process refers to the slender, pointed process (protrusion) of the temporal bone of the skull or the radius and ulna bones of the lower arm. ... Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon. ... “Surgeon” redirects here. ... Fritz de Quervain (1868-1940) was a Swiss surgeon, and a leading authority on thyroid disease. ... 1885 (MDCCCLXXXV) is a common year starting on Thursday of the Gregorian calendar (or a common year starting on Saturday of the 12-day slower Julian calendar). ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... A tendon (or sinew) is a tough band of fibrous connective tissue that connects muscle to bone and is built to withstand tension. ... For other uses, see Thumb (disambiguation). ...


It should not be confused with "De Quervain's thyroiditis" (E06.1). de Quervains thyroiditis, is also known as subacute granulomatous thyroiditis or subacute thyroiditis; usually occurs in women between 30 and 50 years of age. ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other...

Contents

Pathology

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 abductionin (as opposed to movement of the hand 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's syndrome is commonly believed to be an inflammatory condition or tenosynovitis, evaluation of histological specimens shows no inflammatory changes--rather a thickening and myxoid degeneration consistent with a chronic degenerative process are seen. (Clarke MT, Lyall HA, Grant JW, Matthewson MH. The histopathology of de Quervain's disease. J Hand Surg [Br]. 1998 Dec;23(6):732-4.) The pathology is identical in de Quervain's seen in new mothers. (Read HS, Hooper G, Davie R. Histological appearances in post-partum de Quervain's disease. J Hand Surg [Br]. 2000 Feb;25(1):70-2.) De Quervain's syndrome is more common in women as they have a greater styloid process angle of the radius, which the problematic tensdon run over. The Extensor pollicis brevis muscle is a muscle of the human body. ... The Abductor pollicis longus muscle is a muscle of the human body. ...


Cause

The cause of de Quervain's is not known. In medical terms, it remains idiopathic. Idiopathic means arising spontaneously or from an obscure or unknown cause. ...


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 unla deviation especially with a load in the hand such as a child or even a stack of dishes. [1] [2]. A repetitive strain injury (RSI), also called repetitive stress injury, cumulative trauma disorder or occupational overuse syndrome, is any of a loose group of conditions from overuse of the computer, guitar, knife or similar motion or tool. ...


Given that the illness remains idiopathic, any reference to "overuse" or "repetive use" is speculative at best. At worst such a negative illness concept risks blaming innocent bystanders. For instance, the occurrence of de Quervain's in new mothers led some in the past to blame the wringing of cloth diapers. The fact that the illness did not disappear as the use of cloth diapers waned did not lead "overuse" proponents to question their theory--rather, the blame is now often placed on the way the baby is held. This type of speculation should be discouraged without better scientific support, because negative illness concepts increase suffering and feelings of guilt and loss of control at a time when most new mothers can least afford it. The majority of de Quervain's does not occur in new mothers. The fact that de Quervain's remains idiopathic means that its sufferers are blameless victims of an incompletely understood illness.


Symptoms

Symptoms are pain, tenderness, and swelling over the thumb side of the wrist, and difficulty gripping.


Finkelstein's test is used to diagnose DeQuervain's 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: 1. Osteoarthritis of the first carpo-metacarpal joint 2. intersection syndrome - pain will be more towards the middle of the back of the forearm and about 2-3 inches below the wrist 3. Wartenburg's syndrome


Treatment

The natural history of de Quervain's is not well documented. Nonetheless, there is enough observational experience to be fairly certain that it is a self-limited illness with no long-term consequence. The illness tends to last about 1 year on average. There are no treatments that have been scientifically demonstrated to shorten the duration of symptoms, principally because there are no controlled scientific studies. Things that are tried, without support, and with inconsistent results include immobilization, round the clock anti-inlammatory medications, iontophoresis, and corticosteroid injections. Case series of patients receiving one of the most popular treatments (corticosteroid injection) have claimed effectiveness even when the illness did not resolve for months--clearly more study is needed. Operative release is the only known way for predictably shortening the duration of symptoms, but is elective. Surgery consists of opening the tunnels, or sheaths, that the tendons pass through. The pain usually resolves in the time it takes the wound to heal.


While patients await disease resolution, the symptoms of deQuervain's can be managed with a splint that immobilizes the wrist and thumb, anti-inflammatory pain medications (or other non-narcotic pain medications), and ice. While avoiding activities that cause pain will certainly decrease the overall amount of pain experienced, there is no evidence that this will speed recovery, or that continuing to engage in these activities will lead to any harm -- the illness is in general a harmless nuisance. Therefore, patients can safely choose their activity and pain level. It is not dangerous or neglectful to remain active in spite of the pain. The splint can be used as desired to improve function and quality of life during the illness.


Specialised hand therapists (boh physiotherapists and occupational therapists) can provide very effect treatment, which will eventually allow the individual to retern to pain free movement. Splinting (for about 2 weeks) to immobilise the wrist and place the thumb into extesion provides time for the injured tendons to rest and heal. Activity modification is also recommended to aviod repetitive eccentric lowering of the wrist into ulna deviation. Once pain free therapeutic exercise (focusing on eccentric control) are encouraged to strengthen muscles and progressively overload the tendons so that future episodes are avoided.


References

  1. ^ Weiss Orthopaedics - Common Injuries - Wrist/Hand - DeQuervain's Stenosing Tenosynovitis.
  2. ^ OSH Answers: De Quervain's Disease.

External links


 
 

COMMENTARY     


Share your thoughts, questions and commentary here
Your name
Your comments

Want to know more?
Search encyclopedia, statistics and forums:

 


Press Releases |  Feeds | Contact
The Wikipedia article included on this page is licensed under the GFDL.
Images may be subject to relevant owners' copyright.
All other elements are (c) copyright NationMaster.com 2003-5. All Rights Reserved.
Usage implies agreement with terms, 1022, m