Wrist and hand pain often leads people to confuse De Quervain’s Tenosynovitis (DQ) with Carpal Tunnel Syndrome (CTS). While both conditions cause discomfort near the wrist, they are fundamentally different disorders arising from distinct anatomical issues. Understanding the underlying pathology is crucial, as these conditions affect different structures, produce unique sensations, and require separate approaches to management.
Structural Differences
De Quervain’s Tenosynovitis is classified as a form of tendinopathy affecting the tendons that control thumb movement. Specifically, it involves the irritation and inflammation of two tendons, the abductor pollicis longus and the extensor pollicis brevis, located on the thumb side of the wrist. These tendons share a tight fibrous tunnel, known as the first dorsal compartment. Friction from repetitive motion causes the sheath surrounding these tendons to thicken.
Carpal Tunnel Syndrome (CTS), by contrast, is a nerve compression disorder, not a tendon issue. It occurs when the median nerve is squeezed as it passes through the carpal tunnel, a narrow passageway formed by carpal bones and the transverse carpal ligament. This compression results from swelling or thickening of tissues within the tunnel, decreasing the available space for the nerve.
Contrasting Patient Experiences
The subjective experience of these two conditions reflects the distinct structures involved. Patients with De Quervain’s Tenosynovitis typically report sharp, localized pain and tenderness concentrated directly over the bony prominence on the thumb side of the wrist. This pain is mechanical, meaning it is aggravated by specific movements such as grasping, pinching, or forcefully moving the thumb. A classic diagnostic sign is a positive Finkelstein’s test, where bending the wrist toward the little finger while the thumb is held within the fist elicits pain.
Symptoms of Carpal Tunnel Syndrome are neurological, involving numbness, tingling, and a burning sensation, collectively known as paresthesia. These sensations are felt primarily in the thumb, index finger, middle finger, and the thumb-side half of the ring finger, as the median nerve provides sensation to these digits. The discomfort often worsens at night, frequently waking patients from sleep, or when holding the wrist in a flexed or extended position for prolonged periods, such as while driving or reading.
Management Strategies
The difference in pathology dictates the intervention, meaning treatment strategies are tailored to either reduce tendon friction or relieve nerve compression. Initial conservative management for De Quervain’s Tenosynovitis often involves a thumb spica splint, which immobilizes the thumb and wrist to rest the irritated tendons. Corticosteroid injections are typically targeted directly into the first dorsal compartment to reduce the inflammation and swelling of the tendon sheath.
For Carpal Tunnel Syndrome, conservative treatment usually begins with a neutral-position wrist splint, often worn at night. This prevents the wrist from bending and putting pressure on the median nerve. Corticosteroid injections are also common, placed inside the carpal tunnel to decrease the swelling around the compressed nerve.
If symptoms persist despite non-surgical treatments, surgical intervention becomes an option, and the procedures are structurally unique. The goal of surgery for De Quervain’s Tenosynovitis, called a first dorsal compartment release, is to cut open the tight, thickened fibrous sheath. This maneuver creates more space for the inflamed tendons to glide freely, reducing friction and pain.
Carpal Tunnel Syndrome surgery, known as carpal tunnel release, has the objective of decompressing the median nerve. The surgeon cuts the transverse carpal ligament, which forms the roof of the carpal tunnel. This effectively enlarges the tunnel and immediately relieves pressure on the entrapped nerve.