Tendinitis de De Quervain, conocida también como Tenosinovitis Estenosante o Síndrome de la Tabaquera Anatómica, se produce cuando hay inflamación de la vaina que rodea el tendón del músculo Abductor Largo del Pulgar y Extensor Corto del Pulgar los cuales se encuentran en el primer compartimiento dorsal extensor. Para ser más específicos la inflamación ocurre justo sobre el lado externo del hueso radio (apófisis estiloides), formando en ocasiones un nódulo palpable, visible y doloroso.

Causas de la Tendinitis de De Quervain.

  • Movimientos repetitivos que incluyen al pulgar o requieren constantemente de la desviación cubital o radial;
  • Cómo escribir en el teclado o el uso constante del ratón.
  • Realizar actividades que requieran de prensión manual, como enroscar, apretar, hacer pinza con los dedos índice y pulgar.
  • Microtraumatismos recurrentes con las actividades de la vida diarias, directamente sobre la zona del pulgar o parte externa de la muñeca; muchas veces se hace referencia cuando la madre carga constantemente a su bebé con un solo brazo mientras realiza las actividades con el otro.
  • Degeneración tendinosa o en patologías inflamatorias como la artritis reumatoidea.
  • La práctica de algún deporte, como el tenis o golf.

Síntomas de la Tendinitis De Quervain.

  • Dolor e inflamación en la base del pulgar y muchas veces se irradia hacia el lado externo del antebrazo.
  • Entumecimiento en el pulgar.
  • Hipersensibilidad en la zona de la muñeca y el pulgar.
  • Limitación funcional, ya que el dolor muchas veces impide realizar algunas actividades de la vida diaria que requieran el uso del pulgar y la muñeca; como tomar objetos con fuerza o simplemente girar la muñeca para abrir un frasco.

Diagnostico de la Tendinitis de De Quervain.

Generalmente se realiza la maniobra de Finkelstein. En esta prueba, el paciente debe cerrar su mano haciendo un puño con los dedos sobre el pulgar. A continuación la muñeca es doblada en dirección al dedo meñique. Esta prueba puede ser dolorosa para la persona con tendinitis de De Quervain.

Por otra parte, la ecografía de partes blandas resulta un método adecuado para confirmar el diagnóstico.

Tratamiento de la tendinitis De Quervain.

Para que la recuperación sea satisfactoria se recomienda seguir las pautas del médico tratante ya que él será la persona adecuada en indicar el mejor tratamiento para la recuperación.

En  primer lugar el médico enfoca el tratamiento en disminuir el dolor e inflamación, por lo tanto le indica la paciente antiinflamatorios y reposo de la mano afectada utilizando para ello un inmovilizador de pulgar.

El inmovilizador se trata de una Férula la cual tiene como objetivo disminuir la inflamación de los tendones afectados. Se indica utilizarla por 4 semanas de uso diurno y nocturno, luego 2 semanas mas solo para uso nocturno.

Por otro lado si  persiste la molestia y luego de completar la fase de los antiinflamatorios, se recomienda realizar una infiltración con corticoides de la zona afectada, lo que puede reducir las molestias o desaparecerlas hasta en un 50% a 60% de los casos. Tras la infiltración con corticoides es posible complementar el tratamiento con la realización de fisioterapia y un período corto de inmovilización.

En el caso de que falle la infiltración con corticoides se pasa a la última línea de tratamiento que es la liberación quirúrgica del compartimento para liberar los tendones y resolver las molestias. En general el tratamiento quirúrgico tiene buenos resultados en la gran mayoría de los casos.

Fisioterapia en  la tendinitis De Quervain.

El objetivo principal es disminuir el dolor y la inflamación, y para ello se aplica lo siguiente;

  • Crioterapia por 15 minutos en la zona afectada.
  • Electroanalgesia durante 20 minutos.
  • Ultrasonido terapéutico.
  • Masaje suave sobre la zona afectada.
  • Movilizaciones pasivas en el dedo pulgar y la muñeca.
  • Luego si no hay dolor se indica estiramientos pasivos para la muñeca y el pulgar.
  • Se recomienda ejercicios de fortalecimiento para la musculatura comprometida.
  • Estiramientos de la cadena flexora del antebrazo.

Por último, los pacientes deberían ser aconsejados por el terapeuta para evitar los movimientos que provocan dolor, como los que implican giros de la muñeca y pinza con el pulgar (modificación de la actividad).

Hay que evaluar y modificar la ergonomía en el puesto de trabajo y de las afecciones para adaptar una dirección neutra de las muñecas y las manos en actividades como teclear. Esto ayuda a disminuir el uso repetitivo de los tendones comprometidos.

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