Dr. DeQuervain, a Swiss doctor living in Paris in 1890 describes, this malady as washerwomen's disease. DeQuervain's tenosynovitis is an inflammation of the sheath or tunnel which surrounds the tendons of the thumb as they pass through the tunnel from the wrist to the thumb. The cause is often associated with wringing and twisting motions of the wrist. The tendons, which include the abductor pollicus longus and extensor pollicis brevis, are highly prone to tendinosis and tenosynovitis. The definition of tendinosis is a degeneration of the tendon and tenosynovitis is an inflammation of the tendon sheath and the fibrous tunnel (retinaculum).

Symptoms

• Gradual onset of pain
• Dull ache in thumb or wrist
• Pain turning (doorknob, key)
• Pain gripping
• Shooting pain into thumb our up wrist
• Increased pain with activities

The major symptom is aching pain at the wrist and thumb, aggravated by thumb motion. The area at the base of the thumb and wrist is tender to touch and painful with passive stretching. If the hand is made into a fist with the thumb "tucked in" and bent towards the little finger, the pain increases. Sometimes a lump or thickening can be felt in this area. Pain may be present when grasping or pinching or when working against resistance. Swelling and weakness may also be present.

Risk factors

• Age 40 or older
• Rheumatoid arthritis
• Gout
• Diabetes
• Trauma to wrist or hand
• Pregnancy
• Repetitive Activities

The cause may be unknown, but hereditary predispositions of vulnerable tendons as well as increased activity are commonly noted. Many instances occur in middle-aged or older persons, but the malady is uncommon in the 2nd and 3rd decades of age. DeQuervain's can be caused by overuse and repetitive wrist motion, but also trauma to the wrist or hand. It can also be related to systemic diseases (most commonly RA, gout, diabetes) or in association with pregnancy.

Treatment includes immobilization with a thumb splint, anti-inflammatory medication and relative rest, avoiding the inciting activity. A Steroid injection into the tendon sheath may be helpful. A surgical release to enlarge the tendon sheath may be indicated to resolve chronic problems.

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