A Family Doctor's Tale - DE QUARVIAN'S DISEASE

DOC I HAVE DE QUERVAIN'S DISEASE

DE QUERVAIN'S DISEASE is the compression of the tendon sheath of one of the two tendons to the thumb at wrist region.

The tendon sheath is a protective cover for the tendon which provides protection for the tendon as it travels across the radius bone especially at the joints.

DE QUERVAIN'S DISEASE occur as a result of narrowing of the tendon sheath of the thumb and the inflammation of the tendon at the level of the wrist.

When the tendon gets caught in the narrowed sheath, the finger becomes locked in the narrowed tendon sheath resulting in pain and swelling

Women are affected more than men.

It is also known as the washer woman's sprain or recently Blackberry thumb after the name of the popular smart  phone because of repetitive movement of the thumb on the keys of the phone.

Causes of De Quarvian's Disease:
1.trauma of the tendon sheath of the thumb from too much stress on their thumb from carrying their newborn child especially first time parents

2.pressure on the tendon sheath from weight of the newborn's head on the wrist while feeding the baby

3.repetitive use of the thumb on keyboard of Blackberry phone

4.tenosynovitis (inflammation of the tendon and their synovial sheath) as the tendon becomes swollen in the tendon shift as a result of over usage of the wrist especially when wringing clothes

5.common among middle-aged, housewives and those who often use their thumbs or wrists

Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the wrist tendons which causes the patient to seek treatment:

1.swelling and pain of the thumb side of the wrist
2.unable to open door, bottle caps or wring clothes

Physical examination
1.tendon nodules in flexor tendon of the thumb at wrist level

2.tenderness on flexion of the thumb

3.diagnosis is confirmed with CAT scan or MRI

Treatment of De Quarvian's Disease:
1.Rest and splinting of affected thumb and wrist

2.wrist exercise usually good.

3.Non-steroidal anti-inflammatory drugs for inflammation and pain

4.Corticosteroid injection to reduce inflammation under the narrowed sheath

5.Surgery as last resort to release the tendon by cutting the top part of the  narrowed inflamed sheath

Complication of De Quarvian's Disease:
If left untreated. it can lead to the permanent loss of the thumb

Prognosis of De Quarvian's Disease:
1.usually good with injection of corticosteroid

2.recurrence may occur after injection in which case surgery should be done

Prevention of De Quarvian's Disease:
1.Avoid forceful use of the wrist and thumb

2.Avoid carrying newborn baby with head on the wrist

3.Avoid repetitive movement of the thumb.