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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)

Background

  • 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)

Pathophysiology

  • 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

Pathoanatomy


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.[2]

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

Management

Nonoperative

  • Indications
    • Vast majority of cases
    • Conservative treatment is very effective in treating this condition
  • Medications including NSAIDS
  • Corticosteroid 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[3]
    • Harvey et al found an 80% success rate among 71 cases[4]
    • 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

Complications


See Also


References

  1. Anderson M, Tichenor CJ. A patient with de Quervain’s tenosynovitis: a case report using an Australian approach to manual therapy. Phys Ther. 1994;74(4):314–26.
  2. Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 51160
  3. 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
  4. 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
Authors:
Last edited:
15 February 2022 16:42:48
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