Tendovaginitis stenosans de Quervain

(Morbus Quervain or colloquially “mobile phone thumb”)

Tendovaginitis de Quervain: What's that?

Tendovaginitis de Quervain is a carpal tunnel syndrome in the muscular tendon region which moves our thumbs. Synovial tendons are protective covers which reduce pressure and friction on muscular tendons. The fixing fascia (retinaculum extensorum) above the extensor tendon compartments is a constriction which can cause additional pressure load and pain in case of irritations.

The tendons from the following muscles run in the affected first extensor tendon compartment:

1. Long thumb abductor (musculus abductor pollicis longus)
2. Short thumb extensor (musculus extensor pollicis brevis)

These muscles ensure that we can abduct and stretch our thumb.

In case of repeated motion sequences, an overload syndrome may arise on the synovial tendon of these muscles.

Resulting from the overload in conjunction with inflammatory processes, the synovial tendons lose their natural sliding capacity. This increases the pressure load on our tendons.

It is conspicuous that, statistically speaking, women suffer from Tendovaginitis de Quervain more than twice as frequently as men.

Tendovaginitis de Quervain causes

As Tendovaginitis de Quervain is a chronic overload syndrome, recurrent thumb movement is the cause of the complaints:

• House and garden work (e.g. repeated use of scissors)
• Intense mobile phone use (tapping/scrolling with the thumb)
• Holding children in your arms
• Rotary wrist movement
• Gripping movement
• Sports activity, e.g. golf or tennis
• Various everyday tasks

Additional further factors can play a role in its emergence:

• Hormonal changes, e.g. during pregnancy or the menopause (climacteric period) can change the connective tissue structure of the synovial tendons.
• Pre-existing medical conditions such as gout or rheumatism can attack joints or surrounding soft tissue. This can result in swelling of the synovial tendon, causing reduction of the sliding capacity and increased pressure on the muscle tendon.

Tendovaginitis de Quervain can occur together with further overload syndromes such as epicondylitis (tennis or golf arm).

Tendovaginitis de Quervain symptoms

Normally, carpal tunnel syndrome is accompanied by pain, which increases under load.

As the thumb extensor and thumb abductor synovial tendons are affected by Tendovaginitis de Quervain, persons affected primarily have pain during thumb movement. This pain is typically localised in the wrist, below the thumb and occurs, for example, when grasping or holding, in particular with resistance.

Moreover, the following symptoms may be incurred:

• Swelling
• Redness
• Restricted movement

Cracking or audible rubbing indicates that a narrowing (stenosis) of the synovial tendon already exists.

The pain can also radiate to the thumb and lower arm.

Tendovaginitis de Quervain diagnosis

In additional to general case history (questions regarding the course of the ailments), the physical examination is an important component when searching for diagnosis.

The Finkelstein and Eichhoff tests are common clinical tests. They provoke narrowing the thumb extensor tendons.

Additionally, the treating physician can recognise the swollen tendon, e.g. via ultrasound. The diagnosis can also be depicted very clearly visually using MRI images.

Tendovaginitis de Quervain therapy

Morbus de Quervain is normally treated conservatively (without an operation). The patient should primarily avoid movement which induces the symptoms. The objective is to alleviate the swelling and pain. For this, the physician can prescribe aids such as the BORT SellaTex® Plus-Quervain.

The BORT SellaTex® Plus-Quervain is a thumb and hand brace with thumb fixation for wrist and thumb immobilisation which was developed specifically for the diagnosis Morbus de Quervain:

In addition to immobilisation, medication (painkillers, inflammation inhibitors) and manual therapy can alleviate the symptoms.

Further therapeutic options include local cortisone injection, hyaluronic acid or shock wave therapy.

Therapeutic ultrasound can also help to alleviate pain and promote the healing process.

If conservative therapy achieves no improvement, the treating physician can suggest operational therapy. Here, the constricted region is expanded by splitting the extensor tendon compartment. This achieves freer, more pressure-reduced sliding of the tendons.

Tendovaginitis de Quervain prevention

As the ailment is preceded by chronic overburdening and unequal load distribution, preventive attention should be paid to avoiding harmful wrist/thumb postures.

For example, ergonomic measures such as workplace design can promote the healthiness of the wrist/thumb:

• Recurring work with the hand should be interrupted with regular breaks. Additionally, aids such as medical thumb or wrist supports can be applied.
• Avoid/minimise overburdening by carrying heavy loads

Exercises, for example with therapeutic dough for strengthening finger, wrist and lower arm musculature, can reinforce musculature and prevent overburdening symptoms