What is De Quervain's tendovaginitis?
Tendons consist of connective tissue fibers. They connect the muscles to the bones. If the tendons run over bony prominences and joints, they are surrounded by a sheath at these particularly stressed points. The so-called tendon sheath consists of several layers: the outer connective tissue layer and the inner synovial membrane. The latter is named after the viscous fluid that lies between them – the so-called synovia. The task of the tendon sheath is to prevent excessive friction. If the tendon is permanently subjected to severe strain, the tissue of the tendon sheath and sometimes the tendon itself can become inflamed. Specialists also refer to this as tendovaginitis.
In De Quervain’s tendovaginitis, the tendon sheaths of the wrist in the area of the thumb are inflamed. The name goes back to the Swiss surgeon Fritz de Quervain. He was the first to describe tendinitis in 1895.
De Quervain’s tendovaginitis – frequency and age
In general, any tendon sheath in the body can become inflamed. However, the wrist is particularly frequently affected. There is also a difference between the sexes. This is because women generally suffer from De Quervain’s tendovaginitis more often than men.
Tendinitis: causes and risk factors
The cause of De Quervain’s tendovaginitis is usually overuse. This arises, for example, when
- you have to keep bending and stretching your thumb,
- your wrist adopts an incorrect posture in the long term,
- you put a lot of strain on the tendons,
- you often move your wrist sideways.
This causes the tendon to rub strongly over the bone again and again. This can lead to injuries to the tendon sheath, which can sometimes become inflamed.
In principle, any everyday activity can lead to De Quervain’s tendovaginitis. Other risk factors are
- certain sports such as rowing or tennis
- playing instruments such as the violin or piano
- a poorly adjusted workplace
- Diseases such as rheumatism, gout or diabetes
- Hormonal influences such as during pregnancy or while breastfeeding
- Infections
Sometimes De Quervain’s tendovaginitis is also recognized as an occupational disease. Occupational groups that are particularly frequently affected include physiotherapists, professional musicians and people who spend a large part of their working time at a computer.
Tendinitis symptoms
There are various symptoms that are typical of De Quervain’s tendovaginitis. These include:
- stabbing or pulling pain, especially in the wrist below the thumb
- Pressure sensitivity
- Swelling
- Redness
- Restricted movement, often accompanied by a grinding or rubbing sound
If the tendonitis is chronic, nodular thickening can occur. These usually occur above the metacarpophalangeal joint on the inside of the hand. This can lead to the so-called “fast finger”: The affected person can no longer stretch the bent finger properly and a jerky movement occurs.
De Quervain’s tendovaginitis: diagnosis with us
In order to be able to diagnose De Quervain’s tendovaginitis, we will first have a detailed discussion with you. The diagnosis is usually made on the basis of the typical symptoms you describe. Further questions can help to confirm the suspicion:
- What is your profession?
- How long have you had the symptoms?
- When exactly do the problems occur? At rest or in motion?
- Do you have a hobby that puts a lot of strain on your wrist and thumb?
- Do you suffer from any other illnesses?
We will then examine the affected hand more closely, for example to see if you feel any pressure pain or if there is any swelling. You must also move your thumb so that we can detect any restrictions or unusual noises (crunching, rubbing). Another diagnostic method is the so-called Finkelstein text: This involves forming a fist with the affected hand, with the thumb enclosed by the other fingers. Then bend the wrist sideways towards the little finger. If there is pain on the thumb side of the wrist, this is an indication of De Quervain’s tendovaginitis.
Only if there is a suspicion that another illness has caused the symptoms will further examinations be carried out.
Blood test
This allows certain inflammatory markers and other blood values to be determined that are typical of a disease such as rheumatism or gout. A blood test is particularly helpful for diagnosis if pathogens have triggered the tendinitis.
Imaging techniques
We can examine the tissue of the inflamed tendon sheath more closely using imaging techniques such as ultrasound or X-ray.
De Quervain's tendovaginitis: prevention, early detection, prognosis
It is important to recognize De Quervain’s tendovaginitis as early as possible. A typical early sign is that the symptoms occur mainly after exercise and then disappear again. Do not take them lightly and have any pain or similar diagnosed at an early stage. Because then there is the best chance that the inflammation will heal without consequences.
There are also some simple measures you can take to prevent De Quervain’s tendovaginitis:
- Set up your workstation well: If you mainly work at a computer, you should set up your workstation well. Make sure your desk and the chair you are sitting on are at the right height. Aids such as an ergonomically shaped computer mouse or pads in front of the keyboard can also help.
- Don’t overdo it: if your job requires you to perform the same strenuous hand movements over and over again, give yourself a regular break. It is also important not to exaggerate when it comes to hobbies. Sometimes you can also modify certain movement sequences to provide variety.
- Warm up: It is particularly important to warm up before doing sport. In this way, you prepare the stressed areas optimally for the load. This can prevent tendon sheaths from wearing out and causing inflammation.
Course and prognosis
As a rule, De Quervain’s tendovaginitis is uncomplicated and the inflammation usually heals well after a few weeks of consistent rest. This is particularly the case if no other diseases (such as rheumatoid arthritis) are present. In some cases, however, De Quervain’s tendovaginitis can become chronic. This happens, for example, if the disease is not recognized in time or if you do not protect the affected hand sufficiently. The symptoms then persist over a longer period of time and are difficult to treat. This can also lead to thickening, so that the mobility of the thumb is restricted. Often only an operation can help.
Tendon sheath inflammation: Treatment usually without surgery
The treatment of De Quervain’s tendovaginitis depends, among other things, on the underlying cause and how far the inflammation has already progressed.
