De Quervain's Tenosynovitis


De Quervain's Tenosynovitis, De Quervain Syndrome, Extensor Carpi Radialis Tenosynovitis, Stenosing Tenosynovitis

  • Pathophysiology
  1. Inflammation of thumb extensor tendons
    1. Extensor pollicis brevis
    2. Abductor pollicis longus
  2. Occurs where tendons cross radial styloid
  • Variations
  • Extensor Carpi Radialis Tenosynovitis
  1. Affects radial wrist extensors
  2. Seen in heavy laborers
  3. Same signs, symptoms and management as de Quervain's
  • Signs and symptoms
  1. First dorsal extensor compartment (snuff box) symptoms
  2. Crepitation with extensor tendon movement
  3. Local thickening of tendon sheath
  4. Radiation of pain
    1. Ascending up Forearm
    2. Descending down into thumb
  5. Provocative maneuver eliciting pain
    1. Finkelstein Test
    2. Active and passive range of motion of thumb
  • Differential Diagnosis
  1. See Wrist Pain
  2. Ganglion Cyst
  3. Radial Nerve entrapment at Forearm
  4. Wrist extensor Tendinopathy
  5. Osteoarthritis
    1. First extensor compartment
    2. First Metacarpophalangeal joint Osteoarthritis
  • Management
  1. NSAIDs
  2. Immobilization
  3. Avoid offending activity
  4. Moist heat as needed
  5. De Quervain's Tenosynovitis Injection
  6. Surgical correction: first dorsal compartment release
    1. Indicated for persistent symptoms despite above