Tendovaginitis de Quervain

1. tendovaginitis stenosans
("snap finger" or the "snapping finger")

2. tendovaginitis stenosans de Quervain
(inflammation of the extensor tendons on the radius side of the wrist)

What does tendovaginitis stenosans mean?

Tendovaginitis stenosans is a "constricting" (stenosans) inflammation of the tendon gliding tissue (tendovaginitis). The cause is a thickening of the tendon's annular ligament, which normally holds the tendon to the bone. The thickened annular ligament prevents the tendon from gliding normally and gets caught on the annular ligament during movement. This causes the finger to "snap" or "jump", which can also be painful.

This disease can occur in the finger and thumb flexor tendons.

Occasionally, a small ganglion (hard, spherical protrusion of the synovial membrane) is the cause and is also removed during the operation.

If the disease is very advanced, the finger or thumb may no longer be able to be stretched or bent at all.

In small children, parents usually notice that the child can no longer extend the end phalanx of the thumb (so-called pollex flexus congenitus). Here too, surgery is indicated.

Such inflammation often occurs together with carpal tunnel syndrome, so we will also ask you whether your "hands fall asleep", i.e. whether you experience so-called "tingling paresthesia" in the thumb, index and middle fingers.

What does tendovaginitis stenosans de Quervain mean?

If this inflammation occurs on the radius side of the wrist, it is an inflammation of the thumb extensor tendons in the 1st extensor tendon compartment and is called "tendovaginitis de Quervain". Classically, swelling occurs on the radial side of the wrist with pulling pain in the thumb and forearm when gripping or opening cans. The so-called "Finkelstein test" is positive.

Diseases with a different cause must be ruled out, such as arthrosis of the thumb saddle joint (rhizarthrosis), inflammation of the styloid process of the radius (styloiditis radii), unhealed scaphoid fractures with arthrosis of the styloid process of the radius (SNAC-wrist stage I), etc. To rule this out, a careful clinical examination and medical history is carried out and, if necessary, an X-ray examination of the painful region is indicated.

Information on the operation

You should not have any open wounds or scratches on the hand in question before the operation, as this increases the risk of infection. If the skin is very rough and hard, the hand should be treated with a well-lubricating hand cream several days before the operation and, if necessary, a disinfectant hand bath should be carried out the evening before the operation.

The operation is performed in a so-called "tourniquet", i.e. a blood pressure cuff is applied to your arm and inflated in order to be able to operate with as little bleeding as possible and under good vision with magnifying glasses.

In the operation for "tendovaginitis stenosans", the constricting annular ligament above the metacarpophalangeal joint of the finger or thumb is severed (so-called A1 annular ligament splitting in the hand).

During surgery for "tendovaginitis stenosans de Quervain" (inflammation of the extensor tendons in the 1st extensor tendon compartment), the 1st extensor tendon compartment in the wrist is split. Occasionally, a ganglion is found during the operation, which is also removed.

A compression bandage is applied after the skin suture.

Mild symptoms and only occasional "jumping" of the finger or "pulling pain" in the thumb can be treated with anti-inflammatory medication and ointment dressings, possibly with local injection of steroids into the flexor tendon sheath.

In the case of tendovaginitis de Quervain, the inflammation can also be alleviated initially with splint treatment.

Surgery should be performed depending on the degree of suffering and severity of the disease. We are of course available to advise you.

Hospital stay and anesthesia

The operation can be performed under local anesthesia of the hand (local anesthesia), under local anesthesia of the brachial plexus (plexus anesthesia) or under general anesthesia. A hospital stay is not required for this operation.