De Querven's disease is a pathology characterized by inflammation of the tendons on the thumb. The disease manifests itself gradually, is characterized by a rather slow development. Sometimes it takes several weeks or even months before going to the doctor.
Disease Description
De Kerven’s disease (chronic tenosynovitis or stenosing ligamentitis) is a pathology that is characterized by a gradual narrowing of the canal where the tendons of the thumb pass. The disease is accompanied by inflammation of the so-called tendon sheaths. The disease occurs due to a constant load on the hand, often in connection with the implementation of professional activities. Due to pain in patients, the ability to perform certain movements involving absolutely the entire hand decreases.
Periodic contraction of the muscles of the forearm allows flexion / extension of the fingers. The tendons of the flexor muscles (approaching the fingers through the palmar surface) and the extensor muscles (pass through the back of the hand) are responsible for these movements. The transverse ligaments ensure that the tendons are held in position. The back ligament is localized on the same side of the brush. Each group of tendons in the last is in a separate channel. The thumb is actively involved in the daily life of a person. His tendons take on the greatest load. De Querven's disease provokes sequential inflammation of the ligaments, their thickening and swelling. As a result, the channel becomes excessively small, symptoms of the disease occur, and the functioning of the entire brush is impaired.
What causes the development of pathology?
The exact causes of this disease remain unstudied to the end. It is assumed that the constant repetitive activity of the hands (playing golf, gardening, caring for a child) can aggravate this condition. Therefore, sometimes the disease is called the "mother’s wrist."
Also, experts identify a number of factors contributing to the development of pathology, namely:
- Injuries and mechanical damage to the hand.
- Joint diseases of an inflammatory nature (arthritis, arthrosis).
- Constant load on the wrist joint.
- Hormonal restructuring of the body (usually during menopause).
- Anatomical features of the musculoskeletal system.
Who is at risk?
The highest risk of developing this pathology in people aged 30 and up to about 50 years. De Querven's disease is more often diagnosed in the fair sex during pregnancy and newborn care.
What signs are accompanied by pathology?
The main symptom of this disease is pain in the wrist joint area from the thumb. When you turn the brush, discomfort can intensify. The pain often gives off in the forearm and neck.
A hallmark of the disease is considered a symptom of Finkelstein. The man, clenching his hand into a fist, puts his thumb inside. If the next attempt to take the arm to the side is accompanied by sharp pain, de Kerven (disease) can be confirmed.
On palpation of the joint there is a slight swelling, pain on the affected side.
The main mistake of many patients is considered not to seek qualified help, but ordinary immobilization of the hand. For these purposes, tight dressings, special wristbands are used. In this case, the onset of the disease is the cause of disability. Patients cannot carry out even the most familiar housework (peeling potatoes, washing, unbuttoning buttons, etc.).
Establishing diagnosis
Do not disregard de Quervain's disease. Symptoms of pathology, manifested for several days in a row, should alert and become the reason for immediate medical attention.
At the consultation, the specialist performs a physical examination of the affected area, can ask a number of clarifying questions (when the pain appeared, their possible causes). To confirm the diagnosis, the doctor conducts several tests.
- Intense abduction. The specialist presses the thumb from the back so as to bring it to the palm of your hand. On a perfectly healthy hand, the finger should resist pressure. In the case of pathology, pain appears when touched.
- The ability to hold objects. The patient should take an item in each hand. If you pull it slightly, a healthy hand will hold the subject with greater force, which cannot be said about the patient.
- X-ray examination may also confirm de Querven's disease. Photo (snapshot) of the brushes allows you to identify the presence of thickening of soft tissues, changes in the periosteum.
Conservative therapy
First of all, patients are advised to terminate previously carried out activities with mandatory immobilization of the affected area. The immobilization of the brush should be performed so that the thumb is constantly in a bent position with respect to the index and middle. For these purposes, the optimal solution is to use a plaster cast, which is applied to the middle of the forearm. Such immobilization only prevents the joint from possible injury. Additionally, appropriate conservative therapy should be carried out.
Inflammatory changes in the ligaments underlie a pathology such as de Kerven’s disease. Treatment involves the use of physiotherapeutic procedures (paraffin, ultrasound with hydrocortisone). In addition, anti-inflammatory drugs (Ibuprofen, Naproxen), and steroid injections (Hydrocortisone) are prescribed.
When is surgery required?
Surgical intervention is recommended when conservative therapy is ineffective or there is a bilateral lesion.
The operation is carried out in a hospital using a local version of anesthesia. Before the start of immediate anesthesia, the doctor notes with a special marker the most painful area. Then novocaine is introduced, and a transverse incision is made over the area of the so-called styloid process, which passes through this point. With a blunt hook, the subcutaneous tissue together with the veins is extremely carefully moved to the side, the back ligament is exposed. The doctor cuts it and partially removes it. Often with a long course of the disease, tendon fusion with a tendon sheath occurs. In this case, all available adhesions are excised. The wound is sutured, a kerchief bandage is applied. Sutures are removed after about 10 days, disability is finally restored on the 15th day.
It must be taken into account that de Querven (illness) is usually caused by a pathological process in the annular ligament zone. If, after direct surgical intervention, the patient continues to overload the arm, the likelihood of a relapse increases several times. That is why patients are advised to reduce activity, and sometimes even completely change their occupation.
Possible complications
What will happen if de Curven's disease is not treated? Hands over time become more involved in the pathological process, and a person loses his usual ability to work. That is why it is so important in the event of primary symptoms indicating an ailment, seek qualified help from an appropriate specialist. In the case of surgery, there is still a small likelihood of complications such as the formation of a painful scar and impaired thumb movement.
Preventative measures
How to prevent the development of the disease? First of all, doctors recommend that everyone who is at risk reduce physical activity associated with grasping brush movements. In addition, inflammatory diseases of the joints should not be triggered. For injuries or mechanical damage to the hand, it is important to seek the help of a doctor and undergo a course of therapy. Only observing all the above recommendations can prevent the development of pathology.
Conclusion
In this article, we talked about the symptoms that accompany de Querven's disease. Surgery with such a pathology is recommended in 80% of cases. However, timely started conservative treatment is able to eliminate the disease and minimize the development of complications.
We hope that all of the information provided is actually useful to you. Be healthy!