Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 28 2021

De Quervain Tenosynovitis

  • Snapshot
    • A 32-year-old secretary presents with pain over the radial side of her right wrist. She denies any history of wrist trauma. Her pain is aggravated by carrying her 3-month-old son. She is swollen and tender over the radial styloid. Finkelstein test is positive. Radiographs are normal without signs of osseous abnormalities.
  • Introduction
    • Clinical definition
      • stenosing tenosynovial inflammation of the first dorsal compartment tendons
        • abductor pollicis longus (APL)
        • extensor pollicis brevis (EPB)
  • Etiology
    • Posttraumatic
    • Overuse injury
    • Pathoanatomy
      • normal anatomy
        • wrist has 6 dorsal compartments ordered from radial to ulnar
          • 1 - abductor pollicis longus (APL) and extensor pollicis brevis (EPB)
          • 2 - extensor carpi radialis longus (ECRL) and brevis (ECRB)
          • 3 - extensor pollicis longus (EPL)
          • 4 - extensor digitorum communis (EDC) and extensor indices (EI)
          • 5 - extensor digiti minimi (EDM)
          • 6 - extensor carpi ulnaris (ECU)
        • extensor retinaculum overlies the dorsal compartments
      • pathophysiology
        • extensor retinaculum thickens and swells leading to friction with tendon movement
  • Epidemiology
    • Incidence
      • common cause of radial-sided wrist pain
    • Demographics
      • women more likely than men
      • adults more likely than children
    • Risk factors
      • repetitive wrist motion
        • new mothers and day care workers
          • caused by frequent lifting of babies
        • assembly line workers
        • secretaries
        • golfers and racquet sports players
      • traumatic wrist injury
  • Presentation
    • Symptoms
      • radial-sided wrist pain
        • aggravated by thumb and wrist motion
    • Physical exam
      • Finkelstein test
        • ulnar deviation of the hand with the thumb flexed elicits pain
      • tenderness at radial styoid along APL and EPB tendons
      • no tenderness proximally along APL and EPB muscle bellies
  • Imaging
    • Radiography
      • indications
        • needed to rule out bony conditions that could be causing radial sided wrist pain
      • findings
        • normal in De Quervain tenosynovitis as condition is limited to soft tissues (e.g., tendons and fascia)
  • Differential
    • Osteoarthritis of the 1st carpometacarpal joint (base of the thumb)
      • distinguishing factors
        • will demonstrate osteoarthritic changes at the base of the thumb on radiography
        • typically presents over months to years
    • Intersection syndrome (tenosynovitis where the 1st and 2nd dorsal compartments cross)
      • distinguishing factors
        • pain is less radial and more proximal than De Quervain tenosynovitis (2 inches proximal to the wrist)
    • Gamekeeper or Skier thumb (metacarpophlanageal ulnar ligament injury)
      • distinguishing factors
        • caused by radial deviation of the thumb (such as a skier getting their thumb stuck)
        • pain over medial aspect of thumb
          • laxity when lateral force is applied to the thumb
        • thumb spica placement or operative repair
    • Flexor tenosynovitis - a surgical emergency with infection of the flexor sheaths and deep spaces of the hand
      • distinguishing factors
        • pain, tenderness, and swelling over the flexor tendons with erythema and pain with passive rance of motion
      • management
        • broad spectrum antibiotics
        • emergency surgery
  • Treatment
    • Nonoperative
      • rest, NSAIDs, splinting, and steroid injection
        • indication
          • first-line treatment
        • technique
          • thumb spica splint
          • steroid injections into first dorsal compartment
    • Operative
      • surgical release of 1st dorsal compartment
        • indications
          • severe disease that does not improve with non-operative management
  • Complications
    • Superficial radial nerve injury
      • surgical complication due to nerve passing directly over first dorsal compartment
      • supplies sensory function along radial thumb
    • Neuroma
  • Prognosis
    • 90% will resolve within 1 year
1 of 0
1 of 2
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options