De Quervain's Disease: Causes and Treatment at Istituto Clinico San Siro

De Quervain’s disease is a form of tendinitis that can arise from several causes. One of the main causes is the thickening of the retinaculum the fibrous roof covering the internal structures of the wrist.

“This thickening reduces the space within the tunnel that houses the tendons, compressing them and leading to inflammation,” explains Dr. Cedron.

In other cases, the disease causes inflammation of the synovial sheath the tissue surrounding the tendons:

“When the synovium thickens, it increases the volume of the tendons, which then get compressed within the inextensible osteofibrous tunnel,” she adds.

The onset of De Quervain’s disease may also be related to:

• Rheumatic and inflammatory conditions
• Thyroid dysfunctions
• Hormonal imbalances
• Trauma
• Repetitive wrist strain (common in manual tasks like sewing, typing, playing musical instruments, or ping-pong)
• Sudden functional overload

“De Quervain’s is also frequently seen after childbirth, during breastfeeding,” notes Dr. Cedron, “due to both hormonal changes and the repetitive action of holding the baby.”

Symptoms of De Quervain’s include intense pain and significant functional limitation, sometimes accompanied by swelling on the radial side of the wrist, particularly during thumb extension or abduction.

“The pain can seriously interfere with daily activities like turning a key in a lock or brushing one’s hair,” says Dr. Cedron.

Diagnosis is primarily clinical and based on:

• Description of symptoms
• Physical examination
• Specific clinical signs observed during the consultation

Diagnosis can be confirmed with a musculoskeletal ultrasound, ideally a dynamic one performed while moving the wrist and thumb to assess tendon movement inside the tunnel and identify any impingement.

In the early stages, treatment is conservative and includes:

• Rest
• Anti-inflammatory medication
• Use of splints or braces
• Targeted physical therapies

“However, if the patient doesn’t respond to conservative treatments, or if they present in an advanced stage of the disease, surgery becomes necessary,” continues Dr. Cedron.

The surgical procedure, performed under local anesthesia, involves fully cutting the retinaculum and widening the tunnel to relieve pressure and allow the tendons to glide smoothly.

Post-operative care includes a period of rest and avoiding strain in the first few days, while also beginning active hand mobilization as soon as possible.

At Istituto Clinico San Siro, the Hand Surgery Unit III, led by Dr. Carlo Grandis, manages all major conditions affecting the hand, wrist, and elbow. De Quervain’s disease is treated using both conservative and surgical approaches. Treatment plans are personalized and use advanced, minimally invasive techniques.

“A timely and accurate evaluation by a hand specialist is essential to ensure correct diagnosis and define the best therapeutic path for each patient. It’s equally important to identify and address the underlying causes to prevent recurrence sometimes, even small adjustments in daily movements can significantly reduce the chances of the condition coming back,” concludes Dr. Cedron.