What Are De Quervain’s Tenosynovitis And Dupuytren’s Contracture?De Quervain’s tenosynovitis is a very painful condition that involves inflammation of the tendons in the thumb that are responsible for thumb extension. These tendons include the extensor pollicis brevis and the abductor pollicis longus. The inflamed tendons and their covering rub against the tunnel that they pass through resulting in pain at the base of the thumb, which can also extend into the forearm. Additionally, some patients may have swelling and redness of the wrist at the base of the thumb. The symptoms associated with De Quervain’s tenosynovitis can occur gradually or suddenly, and certain activities, especially grasping and pinching tasks, can be quite difficult as the pain can be severe with these thumb movements.
Dupuytren’s contracture is another condition that affects the hand; however, it is a deformity that usually develops slowly and is usually painless. Dupuytren’s contracture affects the layer of tissue that lies under the palmer fascia. The tissue under the skin becomes thickened and knotted. Eventually thick cords form under the surface of skin on the palm. These have the ability to pull fingers into a bent position towards the palm. The most commonly affected fingers are the ring finger and pinky finger. Occasionally, the middle finger may become affected. Dupuytren’s contracture rarely affects the thumb or index finger. When the fingers are affected by Dupuytren’s contracture, they cannot be straightened completely. This can interfere with normal everyday activities, including writing, shaking hands, and putting on gloves.
Causes Of De Quervain’s Tenosynovitis And Dupuytren’s ContractureThe cause of De Quervain’s tenosynovitis is often unknown; it is most common in middle-aged women. Certain activities have been identified that may trigger the disease, including overuse of the thumb, a direct blow to the thumb, repetitive grasping, as well as certain diseases such as rheumatoid arthritis. Additionally, De Quervain’s tenosynovitis has been associated with pregnancy.
Similarly, the cause of Dupuytren’s contracture remains relatively unknown. Researchers have hypothesized that it may be associated with an autoimmune response, whereby the immune system attacks the body. Dupuytren’s contracture more commonly affects older men that are of Northern European descent. Dupuytren’s contracture occurs frequently with conditions that cause contractures in other parts of the body.
While the cause of Dupuytren’s contracture is unknown, various factors have been identified that increase an individual’s risk of developing the condition, including:
- Age: Over 50
- Gender: Male
- Ancestry: Northern European descent
- Genetics: Dupuytren’s contracture tends to run in families
- Lifestyle factors: Smoking and alcohol use
- Medical conditions: Diabetes and epilepsy
Treatments For De Quervain’s Tenosynovitis And Dupuytren’s ContractureDiagnosis of De Quervain’s tenosynovitis is usually based on the appearance of the wrist, location of the pain, and tenderness of the wrist at the base of the thumb. The Finklestein test is the most commonly used orthopedic test that is used to diagnose patients presenting with symptoms of De Quervain’s tenosynovitis. This test involves making a fist, with the thumb placed in the palm of the hand. The patient is then asked to bend their wrist toward the outside. If the patient experiences pain, the test is positive and they may have De Quervain’s tenosynovitis.
Treatment for De Quervain’s tenosynovitis usually involves rest as well as immobilization of the affected joint with a splint for four to six weeks. Additionally, patients are advised to refrain from participating in any activities that aggravate the pain. Home treatment, including the application of ice, may be beneficial for reducing inflammation.
If these treatment methods fail to relieve the patient’s pain, non-steroidal anti-inflammatory drugs (NSAIDs), such as Aleve or Ibuprofen, may be recommended to help reduce inflammation, thereby helping to relieve pain. Additionally, a steroid injection into the affected tendon sheath may help to decrease inflammation and associated pain.
For patients with De Quervain’s tenosynovitis that does not respond to conservative treatment methods, surgery might be warranted. Surgical release of the first dorsal compartment releases the tight covering of the tendon, thereby eliminating the friction that is causing the inflammation. Surgery helps to restore the normal smooth tendon movement.
The prognosis of patients with De Quervain’s tenosynovitis is excellent, with most patients returning to full functioning once the inflammation calms down after treatment.
A diagnosis of Dupuytren’s contracture can usually be made by visualizing and palpating the affected hand. Physicians look for skin puckering on the palms and check for areas of knotting or banded tissue. In most cases, additional tests are not needed to diagnose this condition.
Treatment of Dupuytren’s contracture depends on the severity of the condition. Treatment for cases of mild Dupuytren’s contracture involves stretching of the fingers, heat, and massage. When the palm of the affected hand is constantly sore, ultrasound treatment may be beneficial. Additionally, some patients may benefit from a cortisone injection into the affected area to help control local inflammation.
Treatment for Dupuytren’s contracture that has progressed past the initial stages where the contracture is interfering with normal tasks, involves removing or breaking up the cords of tissue that have developed that are pulling the fingers toward the palm. There are various ways that this can be done, depending on the severity of the condition.
Needling, also known as needle aponeurotomy or needle fasciotomy, is a technique that involves inserting a needle through the skin to puncture the cord of tissue. This technique can be performed on multiple fingers at the same time, and minimal physical therapy is needed after the procedure.
A newer type of treatment is collagenase injection. This injection involves injecting a type of enzyme known as collagenase into the cord of tissue, which helps to soften and weaken it. This allows the physician to manipulate the affected area in an attempt to destroy the cord and straighten the fingers.
Surgery to remove the affected tissue from the palm can be utilized when nonsurgical options have failed. Surgical treatment helps to free the fingers from contracture and release the tendons. Surgical procedures help to restore function to the affected hand.
The prognosis for individuals with Dupuytren’s contracture is good. Typically, the disease progresses slowly and is painless. Additionally, there are a variety of effective treatment options for this condition.
ConclusionDe Quervain’s tenosynovitis and Dupuytren’s contracture are both conditions that affect the hands. De Quervain’s tenosynovitis is a painful condition that occurs due to inflammation of the tendons that control thumb extension. There are various treatment options available for De Quervain’s tenosynovitis and the prognosis is excellent for individuals faced with this condition.
Dupuytren’s contracture occurs due to a thickening of palmer fascia resulting in contracture of the fingers toward the palm. While Dupuytren’s contracture is not painful, it can severely limit an individual’s ability to perform simple tasks, such as writing. There are a variety of treatment options for Dupuytren’s contracture and the prognosis is very good for patients suffering with this condition.
- Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R. Dupuytren’s disease risk factors. J Hand Surg Eur. 2004;29(5):423-426.
- Ilyas AM, Ast M, Schaffer AA, Thoder J. De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15(12):757-764.
- Ilyas AM, Ast M, Schaffer AA, Thoder J. de Quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15(12):757-764.
- Larson D, Jerosch-Herold C. Clinical effectiveness of post-operative splinting after surgical release of Dupuytren’s contracture: a systematic review. BMC Musculoskeletal Disorders. 2008;9:104.
- Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-deJong B. Randomised controlled trial of local corticosteroid injections for de Quervain’s tenosynovitis in general practice. BMC Musculoskeletal Disorders. 2009;10:131.
- Richie CA, Briner WW. Corticosteroid injection for treatment of de Quervain’s tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Med. 2003;16(2):102-106.
- Skoff H. The surgical treatment of Dupuytren’s contracture: a synthesis of techniques. Plastic & Reconstructive Surgery. 2004;113(2):540-544.