De Quervain's Tenosynovitis 

de Quervain tendinopathy:
the extensor tendons, which extend the wrist and fingers, travel over the posterior aspect of the wrist and are held in place by the extensor retinaculum.
they are enclosed within synovial tendon sheaths.
These sheaths reduce the friction to the extensor tendons as they traverse the compartments
that are formed by the attachments of the extensor retinaculum to the distal of the radius and ulna.
the 1st dorsal compartment on the thumb side of the wrist contains:
the extensor pollicis brevis (EPB)
and abductor pollicis longus (APL) tendons.
these tendons extend and abduct the thumb.
De Quervain's Tenosynovitis is a stenosing tenosynovial inflammation of the 1st dorsal compartment.
de Quervain Tenosynovitis is a common cause of wrist pain in adults.
It is most commonly diagnosed among women,
between the ages of 30 and 50 years of age.
The dominant hand is no more likely to be involved than the nondominant hand,
and the disease can be bilateral.
It is often attributed to overuse or repetitive movements of the wrist or thumb.
Other causes of de Quervain tenosynovitis include:
Inflammatory arthritis, such as rheumatoid arthritis.
Direct injury to the wrist or tendon, which may cause scar tissue that restricts movement of the tendons.
Fluid retention, such as from changes in hormones during pregnancy.
new mothers are at risk postpartum due to repetitive motion of hands required to lift and hold newborns.
These women tend to develop symptoms about four to six weeks after delivery.
it can also happen to people for no obvious reason.
symptoms:
Patients with de Quervain tendinopathy describe pain at the thumb side (radial side) of the wrist that is more notable with thumb and wrist movement.
The pain may radiate to the thumb or forearm.
Some patients may also notice some enlargement and tenderness on the radial side of the wrist.
The diagnosis of de Quervain tendinopathy is based upon the characteristic history of atraumatic radial wrist pain.
the doctor will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.
Resisted extension and abduction of the thumb causes pain.
the patient may be asked to perform a special test,
in which he bends his thumb across the palm of his hand and bend his fingers down over his thumb.
Then he bends his wrist toward his little finger.
If this causes pain on the thumb side of his wrist, he likely has de Quervain tenosynovitis.
Radiographs are normal in patients with this disorder and usually not indicated.
treatment
To reduce pain and swelling, the doctor may recommend using nonsteroidal anti-inflammatory drugs (NSAIDs).
unless contraindicated by gastrointestinal, renal, respiratory, or heart disease.
Avoiding activities that cause pain and swelling. Especially avoid those that involve repetitive hand and wrist motions.
Applying ice to the affected area every 4 to 6 hours, for 15 minutes each time.
Wearing a splint 24 hours a day for 4 to 6 weeks to rest your thumb and wrist.
A physiotherapist can advise the patient on exercises to help strengthen muscles and relieve symptoms,
If you start treatment early, most de Quervain tendinopathy resolves without surgery
your symptoms should improve within 4 to 6 weeks.
If de Quervain tenosynovitis starts during pregnancy,
symptoms are likely to end around the end of either pregnancy or breastfeeding.
For patients with persistent pain and swelling despite splinting and NSAIDs,
we suggest a local glucocorticoid injection 1st dorsal compartment.
Some patients who present with severe symptoms may benefit from a glucocorticoid injection at the initial presentation.
concomitant splinting and/or NSAIDs after steriods injection does not improve outcomes.
Surgery is generally reserved for patients with persistent symptoms despite nonoperative therapy and glucocorticoid injection.
In the procedure,
the surgeon inspects the sheath surrounding the involved tendons and then opens the sheath to release the pressure.
This allows the tendons to glide freely.
Surgery can be done as a simple office procedure using local or regional anesthesia.
This usually results in very rapid if not immediate relief of the pain and stiffness.
the doctor may recommend that you wear a splint on your hand for 1 to 4 weeks after surgery.
Many individuals will begin to use their hands for simple daily activities immediately after surgery as pain allows,
for the first couple of weeks, heavy lifting or pulling should be avoided.
Most patients who have de Quervain’s release surgery will regain full use of the hand, with full motion and full return of strength within 4 to 6 weeks after surgery.
the patient may drive as soon as you can comfortably grip the steering wheel with both hands.
Most people can return to work within 1- 4 weeks
whilst heavy manual workers may need at least 6 weeks to return to work.