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De Quervain's Tenosynovitis

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

  • See Also
  1. Overuse Syndromes of the Hand and Wrist
  • Epidemiology
  1. Most common in women 30 to 50 years old
  2. Also more common at 4 to 6 weeks postpartum
  • History
  1. First described by the swiss surgeon Fritz de Quervain in 1895
  • Pathophysiology
  1. Tendon Entrapment and inflammation of the thumb extensor tendons
    1. Extensor pollicis brevis tendon
    2. Abductor pollicis longus tendon
  2. Occurs where tendons cross radial styloid
    1. First dorsal extensor compartment of the radial wrist
    2. Associated with overuse with repetitive wrist or thumb movement
  3. 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
  • Risk Factors
  1. Pregnancy
  2. Repetitive motion of the thumb and wrist (e.g. hammering, knitting)
  3. Heavy lifting
  4. Rheumatoid Arthritis
  5. Diabetes Mellitus
  • Findings
  • Signs and symptoms
  1. Tenderness and swelling at the radial wrist (thumb base or radial styloid)
    1. First dorsal extensor compartment (snuff box) symptoms
    2. Crepitation with extensor tendon movement
    3. Local thickening of tendon sheath
  2. Radiation of pain
    1. Ascending up Forearm
    2. Descending down into thumb
  3. 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. Thumb spica spint immobilization
  3. Avoid offending repetitive 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
  • References
  1. Shehab (2013) Am Fam Physician 87(8): 568-73 [PubMed]
  2. Pujalte (2024) Am Fam Physician 110(4): 402-10 [PubMed]