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De Quervain described a tightening of the tendon sheaths of the thumb extensor tendon in 1895. Two tendons that move the thumb away from the hand go through a tight tunnel, which reacts to prevent bowstringing of the tendon. De Quervain's disease involves thickening of the tunnel through which the two tendons pass. As the tunnel thickens so the tendons get squeezed and painful. De Quervain's disease is more common in females at a ratio of two to one. 66% occur in the dominant hand and it tends to occur in forty to fifty year olds. It can result from direct trauma though the vast majority do not do so. It is common in nursing mums.

Symptoms

Pain and tenderness on the thumb side of the wrist, which are particularly aggravated by use or movement of the thumb. For example ringing out cloths, opening jars, stretching to get hold of large objects. Sometimes there is a lump over the tender spot.

On examination

There is pain and tenderness over the base of the thumb. There is sometimes a lump that is present. There is also a physical sign called crepitus which is a creaking sensation over the base of the thumb when the thumb is moved. Resistance of the thumb is proven in the hitchhiking position and that movement is resisted. This also can give pain. With the thumb bent into the palm and held in there by all four fingers and then the wrist is moved towards the little finger side. This can cause pain (Finkelstein's Test).


Treatment
  1. Rest - it is impossible to limit normal activities of the thumb without a splint. A De Quervain's splint can be useful and this will certainly adequately rest the tendon and can lead to resolution of the symptoms.
  2. Non-steroidal anti-inflammatory tablets or gels can relieve the symptoms but there is no evidence that they have any affect long term on the outcome of the condition.
  3. Steroid injection - injection of the sheath with steroid in the form of Depo-Medrone or preferably Triamcinolone is effective in 70% of cases. The injection has no general side-effects but it can cause some de-pigmentation of the skin locally.
  4. Surgery - if the pain persists, despite these other treatments the problem can be resolved by a simple surgical release of the sheath.