De Quervain’s Tenosynovitis & Dupuytrens Contracture

//De Quervain’s Tenosynovitis & Dupuytrens Contracture
De Quervain’s Tenosynovitis & Dupuytrens Contracture 2018-10-12T17:16:34+00:00

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 your thumb extending. Dupuytren’s contracture is another condition that’s often mistaken for this condition, but it is different. If you think you’re suffering from either condition, there is help. Here’s what you should know.

The tendons of the thumb include the extensor pollicis brevis and the abductor pollicis longus. When they become inflamed, their covering can rub against the tunnel that they pass through. This can lead to pain at the base of the thumb, which can also extend into the forearm. Additionally, some people have swelling and redness near their wrist at the base of the thumb. De Quervain’s tenosynovitis symptoms can occur gradually or suddenly. Certain activities, especially grasping and pinching tasks, can become quite difficult as the pain progresses.

Dupuytren’s contracture is another similar 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 Dupuytren’s contracture occurs, fingers cannot always be straightened completely. This can interfere with your normal everyday activities, including writing, shaking hands, and putting on gloves.

De Quervain’s Tenosynovitis And Dupuytren’s Contracture Causes

The cause of De Quervain’s tenosynovitis is often unknown. It is most common in middle-aged women, though. Certain activities may trigger symptoms, including:

  • Overuse of the thumb
  • A direct blow to the thumb
  • Repetitive grasping or pinching
  • Certain diseases such as rheumatoid arthritis

Additionally, De Quervain’s tenosynovitis has been associated with pregnancy.

Similarly, Dupuytren’s contracture cause remains relatively unknown. Researchers hypothesize that it may be associated with an autoimmune response. Dupuytren’s contracture more commonly affects older men that are of Northern European descent. Dupuytren’s contracture occurs frequently with conditions that cause contractions 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

Diagnosis And Testing

Diagnosis of De Quervain’s tenosynovitis is usually based on:

  • The appearance of the wrist
  • Location of the pain
  • Tenderness of the wrist at the base of the thumb

The Finklestein test is a common orthopedic test that can diagnose patients 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.

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.

De Quervain’s Tenosynovitis Treatments

Treatment for De Quervain’s tenosynovitis usually involves rest. Doctors may also recommend immobilization of the affected joint with a splint for four to six weeks.

Additionally, patients should usually refrain from participating in any activities that aggravate their pain. Finally, treating the area with ice (cold therapy) may reduce inflammation

Interventional procedures

If these treatment methods don’t relieve your pain, non-steroidal anti-inflammatory drugs (NSAIDs), such as Aleve or Ibuprofen, can help reduce inflammation.  Additionally, a steroid injection into the affected tendon sheath may help to decrease inflammation and pain. You can learn more about this technique in the following video.

For patients with De Quervain’s tenosynovitis that does not respond to these conservative treatment methods, surgery might be necessary. Your doctor can surgically release the first dorsal compartment which releases the tight covering of the tendon, thereby eliminating the friction and inflammation. Surgery helps to restore normal smooth tendon movement.

After treatment, prognosis of De Quervain’s tenosynovitis is excellent. Most patients return to full functioning once the inflammation reduces after treatment.

Dupuytren’s Contracture Treatments

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 hand is constantly sore, ultrasound treatment may also help.

Interventional procedures

If symptoms progress past the initial stages and the contracture is interfering with your normal everyday tasks, there are more interventional treatments. Some patients may benefit from a cortisone injection into the area to help control local inflammation.

Another procedure involves removing or breaking up the cords of tissue that are pulling the fingers toward the palm. There are various ways to do this, 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. Minimal physical therapy is needed after this type of procedure.

Another option is a 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 a physician to manipulate the area in an attempt to destroy the cord and straighten the fingers.

Finally, your doctor may use surgery to remove the affected tissue from the palm. Surgical treatment helps to free the fingers from contracture and release the tendons. Surgical procedures help to restore function.

The prognosis for individuals with Dupuytren’s contracture is also good. Typically, the disease progresses slowly and is painless. Additionally, there are a variety of effective treatment options for this condition, ranging from at-home treatments to more interventional surgeries.

Conclusion

De 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. The prognosis is very good for patients suffering with this condition.

If you need help with these conditions, it may be time to talk to a pain specialist. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.

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References

  1. Geoghegan JM, Forbes J, Clark DI, Smith C, Hubbard R. Dupuytren’s disease risk factors. J Hand Surg Eur. 2004;29(5):423-426.
  2. Ilyas AM, Ast M, Schaffer AA, Thoder J. De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15(12):757-764.
  3. Ilyas AM, Ast M, Schaffer AA, Thoder J. de Quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007;15(12):757-764.
  4. 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.
  5. 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.
  6. 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.
  7. Skoff H. The surgical treatment of Dupuytren’s contracture: a synthesis of techniques. Plastic & Reconstructive Surgery. 2004;113(2):540-544.

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