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Optimal Care for De Quervain's Tenosynovitis: Best Treatment – Unmatched Solutions in Kolkata

De Quervain's Tenosynovitis Best Treatment Dr debjyoti dutta

In This Article - Discover the optimal care for De Quervain's Tenosynovitis with the best treatment in Kolkata. Get unmatched solutions at Samobathi Pain Clinic.


De Quervain's Tenosynovitis is a condition that causes pain in the tendons of the wrist near the thumb. It can make it hard to move the wrist, hold things, or make a fist.

The exact cause of this condition is unknown, but it may be related to activities that involve repeated hand or wrist movements, such as gardening, golfing, racket sports, or lifting a baby. These activities can make the condition worse.


 

What are the symptoms of De Quervain's Tenosynovitis?


  • Having pain and swelling at the bottom of the thumb. The patient may face trouble using the thumb and wrist for grasping or pinching things.

  • It can cause pain and swelling near where the thumb meets to wrist. It can also make it hard to move the thumb and wrist when need to grip or pinch something. The thumb may not move smoothly and may feel like it snaps or catches.

  • The symptoms of De Quervain's Tenosynovitis include pain and swelling at the base of the thumb. The condition can also affect the movement of the thumb and wrist, especially when doing activities that involve gripping or pinching. The thumb may have a “sticking” or “stop-and-go” feeling when moving it.

 

The Causes of De Quervain's Tenosynovitis:


The two tendons that connect the thumb to the wrist are affected by De Quervain's Tenosynovitis. Tendons are like ropes that link muscle to bone.

When the tendons are used too much, such as by doing the same hand motion over and over, the covering around them may get inflamed. This inflammation can make the tendons thicker and bigger. This makes it harder for the tendons to move through the small tunnel that leads them to the base of the thumb.


Some other factors that can cause De Quervain's Tenosynovitis are:

  • Arthritis that causes inflammation, such as rheumatoid arthritis.

  • Injury to the wrist or tendon, which may create scar tissue that limits the movement of the tendons

  • Fluid buildup, such as from hormonal changes during pregnancy

 

Risk Factors of De Quervain's Tenosynovitis:


The following factors can increase the risk of developing De Quervain's Tenosynovitis:

  • Age. The condition is more common in people who are between 30 and 50 years, old compared to other age groups, including children.

  • Sex. Women are more prone to the condition than men.

  • Pregnancy. The condition may have a connection to pregnancy.

  • Baby care. The condition may be caused by lifting a child repeatedly, which uses the thumbs as leverage.

  • Repetitive hand and wrist motions. The condition may be worsened by doing jobs or hobbies that involve repeated hand and wrist movements.


How to Diagnose De Quervain's Tenosynovitis:


The diagnosis of De Quervain's tenosynovitis is primarily based on a clinical examination by a healthcare professional. However, in some cases, additional investigations may be recommended to confirm the diagnosis or rule out other possible causes of symptoms. Common investigations for De Quervain's tenosynovitis include:

  1. Physical Examination: A thorough physical examination is usually the first step in diagnosing De Quervain's tenosynovitis. The healthcare provider may check for tenderness, swelling, and pain in the affected area, and may perform specific maneuvers to reproduce symptoms.

  2. Finkelstein Test: This is a specific physical test for De Quervain's tenosynovitis. During the Finkelstein test, the patient makes a fist with the thumb inside the fingers, and the wrist is then bent towards the little finger. Pain along the thumb side of the wrist during this manoeuvre can be indicative of De Quervain's tenosynovitis.

  3. Imaging Studies:

  • Ultrasound: Ultrasonography may be used to visualize the tendons and the sheath around them. This imaging technique can help confirm the diagnosis and assess the severity of inflammation.

  • MRI (Magnetic Resonance Imaging): In some cases, an MRI may be recommended to provide detailed images of the wrist structures. This can be especially useful if there is uncertainty about the diagnosis or if other conditions are suspected.

  1. Blood Tests: Blood tests are typically not required for the diagnosis of De Quervain's tenosynovitis, but they may be ordered to rule out other conditions with similar symptoms, such as inflammatory arthritis.



Finkelstein Test for  De Quervain's Tenosynovitis
Finkelstein Test for De Quervain's Tenosynovitis


Treatment of De Quervain's Tenosynovitis: The aim of treating De Quervain's Tenosynovitis is to ease the swelling, keep the thumb moving, and prevent the condition from coming back.


Initial treatment of De Quervain's Tenosynovitis is:

  • To help the tendons rest, need to wear a splint or brace that keeps the thumb and wrist straight and still.

  • To avoid making the condition worse, need to limit the thumb movements that can be repeatedly

  • To prevent more pain, need to stop pinching with the thumb when moving the wrist from side to side.

  • To reduce the swelling, need to apply ice on the affected area


NSAIDS - The doctor may suggest medicines to ease the pain and swelling. These include ibuprofen and naproxen sodium.


Doctors also can give corticosteroid medications to the covering of the tendon to shrink the swelling. If the treatment starts within the first six months of having symptoms, most people get better completely after getting corticosteroid shots, sometimes after just one shot.


Ultrasound-guided corticosteroid injections For De Quervain's Tenosynovitis


Ultrasound-guided corticosteroid injections are a technique that involves using ultrasound imaging to precisely guide the injection into the affected area. This can enhance the accuracy of the injection and improve the overall effectiveness of the treatment.


Here's an overview of the process:


Ultrasound Guidance: Ultrasound is a real-time imaging technique that allows the healthcare provider to visualize the affected tendon and surrounding structures. This imaging can help ensure that the corticosteroid is injected directly into the inflamed area, improving the chances of symptom relief.


Injection Procedure: The injection procedure typically involves the following steps:

  • The patient is positioned to provide optimal access to the affected area.

  • The skin is cleaned, and a local anaesthetic may be applied to minimize discomfort.

  • The healthcare provider uses ultrasound to visualize the tendons and guide the needle precisely into the affected sheath.

·        The corticosteroid medication is then injected into the inflamed area.


Post-Injection Care: After the injection, your healthcare provider may recommend limiting the use of the affected hand and applying ice to reduce any potential swelling. Rest and avoidance of activities that may exacerbate symptoms are also commonly advised.

Follow-Up: It's important to follow up with your healthcare provider to monitor your progress and determine if additional injections or alternative treatments are needed.

Using ultrasound guidance for corticosteroid injections has the advantage of increased precision, as it allows the healthcare provider to visualize the affected structures in real time. This can lead to more accurate placement of the medication and potentially better outcomes for the patient.

As with any medical procedure, there are potential risks and benefits associated with ultrasound-guided corticosteroid injections, and your healthcare provider will discuss these with you based on your individual health and circumstances.



Platelet-rich plasma (PRP) injections For De Quervain's Tenosynovitis


De Quervain's Tenosynovitis treatment – Platelet-Rich Plasma (PRP) injections. Harnessing the body's own healing power, PRP therapy offers a promising approach to alleviate pain and inflammation in the thumb tendons. Discover the innovative potential of PRP as we delve into its role in promoting swift recovery and improved wrist function.


1.     Blood Collection: A small amount of the patient's blood is drawn, usually from the arm.

2.     Centrifugation: The blood is then placed in a centrifuge, a machine that spins rapidly to separate its components. This process isolates the platelets and other growth factors from the rest of the blood.

3.     Plasma Enrichment: The concentrated platelets, along with other bioactive proteins, are mixed with a small amount of the liquid part of the blood (plasma), creating platelet-rich plasma.

4.     Injection: The platelet-rich plasma is then injected directly into the affected area, in this case, the sheath around the tendons causing De Quervain's Tenosynovitis.

The idea behind PRP therapy is that the growth factors and other bioactive substances in the platelets can stimulate the body's natural healing processes, promoting tissue repair and reducing inflammation. This may be particularly beneficial in conditions like De Quervain's Tenosynovitis, where inflammation of the tendons is a key factor.

It's important to note that while PRP therapy has shown promise in treating various musculoskeletal conditions, including some types of tendonitis, the scientific evidence supporting its effectiveness for De Quervain's Tenosynovitis specifically is still evolving.



About the author


Dr Debjyoti Dutta

Dr Debjyoti Dutta is a prominent pain specialist and accomplished author associated with Samobathi Pain Clinic and Fortis Hospital in Kolkata. Currently holding the position of registrar at the Indian Academy of Pain Medicine, Dr. Dutta specializes in musculoskeletal ultrasound and interventional pain management. Widely recognized for his expertise, he has made significant contributions to the field, with impactful publications like "Musculoskeletal Ultrasound in Pain Medicine" and "Clinical Methods in Pain Medicine," offering profound insights into the realm of pain management. Beyond his clinical commitments, Dr. Dutta serves as a faculty member for the Asian Pain Academy Courses. In this role, he plays a pivotal part in delivering high-quality pain management fellowship training in Kolkata, India, contributing to the education and development of professionals in the field.

 


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