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De Quervains Tenosynovitis

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Other Names

  • Washerwoman's Sprain or Strain
  • Stenosing Tenosynovitis
  • De Quervain's Tenosynovitis (DQTS)
  • de Quervain syndrome

Background

Illustration of the first dorsal compartment[1]
  • This page refers to stenosing tenosynovitis of the first dorsal (extensor) compartment of the wrist

History

  • Named after Swiss surgeon Fritz De Quervain

Epidemiology

  • Second most common entrapment tendinopathy of hand behind Trigger Finger (need citation)

Introduction

General

  • Generally associated with overuse, although direct trauma can also be a source

Etiology

  • The extensor retinaculum creates a fibroosseus tunnel, securing the APL and EPB tendons
  • Thickening of the retinaculum from repetitive microtrauma restricts normal gliding
  • Subsequently, there is swelling, thickening, remodeling and ultimately stenosing of the sheath
    • Note this is not generally considered to be an inflammatory process

Anatomy of the First Dorsal Compartment


Risk Factors

  • Demographic
    • Female > Male
    • Middle Age
  • Occupational risk factors
    • Mothers and childcare workers
    • Secretarial occupations
    • Nursing

Differential Diagnosis

DDx Finger and Hand Pain

DDx Wrist Pain


Clinical Features

History

  • Patients typically report gradual onset of pain in thumb and wrist
  • Worse with movement
  • They report pain specifically over the radial styloid
  • Symptoms can be bilateral

Examination: Physical Examination Wrist

  • They will be tender at some point along the tendon distribution, most commonly at radial styloid
  • Triggering or crepitus may be appreciated
  • Range of motion, neurovascular exam typically normal

Special Tests


Evaluation

Short axis view of De Quervain's. Thickening of tendon, hypoechoic fluid surrounds the EPB tendon. Note the difference compared to APL.[3]

Radiographs

Ultrasound

  • Often diagnostic if clinical uncertainty exists
  • Findings
    • Will show edema or thickening of tendons
    • Increased fluid within the first extensor compartment
    • Thickening of retinaculum
    • "Hypoechoic Halo Sign": peritendous subcutaneus edema

MRI

  • Sensitive and specific for De Quervain's
    • Helpful to evaluate for intertendinous septum, which increases likelihood of surgical intervention
  • Findings
    • Increased fluid within tendon sheath
    • Debris within sheath
    • Thickened retinaculum
    • Peritendinous subcutaneus edema and contrast enhancement

Classification

  • Not applicable

Management

Nonoperative

  • Indications
    • Vast majority of cases
    • Conservative treatment is very effective in treating this condition
  • Medications including NSAIDS
  • First Dorsal Compartment Injection
    • Sawaizumi et al studied 36 patients with DQTS, 50% of patients experience resolution of symptoms with 1 while another 40% experienced resolution after a second injectioninjection[4]
    • Harvey et al found an 80% success rate among 71 cases[5]
    • Use of ultrasound is recommended if possible, although not required
  • Thumb Spica Splint
  • Physical Therapy

Operative

  • Indications
    • Refractory cases
  • Technique
    • Surgery entails release of 1st dorsal compartment
    • Intertendinous septum between APL And EPB increases likelihood of intervention

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis

Prognosis

  • Needs to be updated

Complications


See Also

Internal

External


References

  1. Image courtesy of https://www.ntxortho.com/, "De Quervain’s Tenosynovitis"
  2. Motoura H, Shiozaki K, Kawasaki K. Anatomical variations in the tendon sheath of the first compartment. Anat Sci Int. 2010 Sep;85(3):145–151. Epub December 29, 2009.
  3. Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 51160
  4. Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31 (2): 265-8. doi:10.1007/s00264-006-0165-0
  5. Harvey FJ, Harvey PM, Horsley MW. De Quervain’s disease: surgical or nonsurgical treatment. J Hand Surg. 1990;15A:83–7.
Created by:
John Kiel on 11 June 2019 01:53:32
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Last edited:
6 February 2024 20:44:34
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