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De Quervains Tenosynovitis

From WikiSM

Other Names

  • Washerwoman's Sprain or Strain
  • Stenosing Tenosynovitis
  • De Quervain's Tenosynovitis (DQTS)
  • de Quervain syndrome
  • De Quervain’s disease
  • De Quervain’s tendinitis
  • De Quervain’s stenosing tenosynovitis
  • Radial styloid tenosynovitis
  • First dorsal compartment tenosynovitis
  • Texting thumb
  • Gamer’s thumb
  • Mommy thumb

Background

History

  • Named after Swiss surgeon Fritz De Quervain[1]

Epidemiology

  • Second most common entrapment tendinopathy of hand behind Trigger Finger (need citation)
  • More commonly occurs in women with a peak age between 40 and 59[2]
    • Female-to-male ratio of approximately 2.6:1
  • Overall prevalence is estimated at 0.5% in men and 1.3% in women[3]

Introduction

Overview of Pathophysiology, Diagnosis, and Treatment of de Quervain Tenosynovitis[2]
Illustration of the first dorsal compartment[4]

General

  • Presents with subacute dorsal/radial thumb and wrist pain
  • Generally associated with overuse, although direct trauma can also be a source
  • Diagnosis is clinical but can be confirmed with MRI and ultrasound
  • Treatment is nonsurgical including NSAIDS, brace, physical therapy, activity modification and injections

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
  • Black Women

Occupational/ Activity risk factors

  • Mothers and childcare workers
  • Secretarial occupations
  • Nursing
  • Repetitive, forceful, or ergonomically stressful manual work
  • Smartphone use

Other

Differential Diagnosis

DDx Finger and Hand Pain

DDx Wrist Pain

Clinical Features

Pain regions unique to intersection syndrome (IS) and de Quervain's tenosynovitis (DQT). IS typically presents with a pain region more proximal and dorsal than that presenting with DQT.[7]
Visualization of the swelling that occurs in the region of the first dorsal compartment with de Quervain ’ s tenosynovitis[8]

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

De Quervain tenosynovitis. a Plain radiograph showing a non-specific soft tissue swelling at the radial styloid process (arrow). b Transverse ultrasound showing fluid surrounding the extensor pollicis[9]
Short axis view of De Quervain's. Thickening of tendon, hypoechoic fluid surrounds the EPB tendon. Note the difference compared to APL.[10]

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

Suggested Treatment Algorithm for de Quervain Tenosynovitis (DQT)

Long Thumb Spica Brace

Orthoses used in de Quervain's disease.[11]

Goals

  • Pain reduction
  • Restoration of function
  • Prevention of recurrence

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 injection[12]
    • Harvey et al found an 80% success rate among 71 cases[13]
    • Use of ultrasound is recommended if possible, although not required
  • Thumb Spica Splint or thumb spica brace
  • 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

  • General
    • Acute phase: gentle massage therapies, range of motion
    • Subacute phase: stretching and progressive strengthening
    • Return to function: functional strengthening, ergonomic training, return to work/play
  • Physical therapy modalities to consider
    • Paraffin Bath
    • Laser Therapy[14]
    • Therapeutic ultrasound

Return to Play/ Work

  • There are no high quality, sport specific RTP protocols
  • ACSM RTP Criteria[15]
    • Complete pain resolution
    • Restoration of normal strength and range of motion
    • Ability to perform sport-specific skills
    • Psychosocial readiness
  • Stepwise RTP example
    • Immobilization/rest phase (3–4 weeks) with thumb spica splinting[16]
    • Gradual reintroduction of pain-free range-of-motion and strengthening exercises[15]
    • Progression to sport-specific drills and functional testing
    • Full return to play only when the athlete is pain-free, with normal strength and function, and poses no risk to self or others

Complications and Prognosis

Prognosis

  • General
    • Favorable, with most patients achieving symptom resolution and functional recovery
    • Usually can improve within weeks to a few months with conservative therapy
  • Nonsurgical
    • Improvement in pain and function can be seen within 3-6 weeks[17]
    • Addition of corticosteroids improves recovery to 84-90% within 3-4 weeks[18]
  • Surgery
    • Not typically indicated unless conservative therapy fails
    • Surgical release has a success ate up to 95% (need citation)

Complications

  • Persistent/ Chronic pain
  • Functional impairment
  • Reduction in grip strength
  • Limited thumb/wrist range of motion
  • Impairment in activities of daily living
  • Superficial radial nerve injury
  • Subluxation
  • Neuroma
  • Complex Regional Pain Syndrome

See Also

Internal

External

References

  1. ↑ Ahuja, Naveen K., and Kevin C. Chung. "Fritz de Quervain, MD (1868–1940): stenosing tendovaginitis at the radial styloid process." The Journal of hand surgery 29.6 (2004): 1164-1170.
  2. ↑ 2.0 2.1 Currie, Kelly Bettina, Kashyap Komarraju Tadisina, and Susan E. Mackinnon. "Common hand conditions: a review." Jama 327.24 (2022): 2434-2445.
  3. ↑ Hassan, Kareem, et al. "De Quervain tenosynovitis: an evaluation of the epidemiology and utility of multiple injections using a national database." The Journal of Hand Surgery 47.3 (2022): 284-e1.
  4. ↑ Image courtesy of https://www.ntxortho.com/, "De Quervain’s Tenosynovitis"
  5. ↑ 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.
  6. ↑ Wolf, Jennifer Moriatis, Rodney X. Sturdivant, and Brett D. Owens. "Incidence of de Quervain's tenosynovitis in a young, active population." The Journal of hand surgery 34.1 (2009): 112-115.
  7. ↑ Skinner, Thomas M. "Intersection syndrome: the subtle squeak of an overused wrist." The Journal of the American Board of Family Medicine 30.4 (2017): 547-551.
  8. ↑ Goel, Ritu, and Joshua M. Abzug. "de Quervain's tenosynovitis: a review of the rehabilitative options." Hand 10.1 (2015): 1-5.
  9. ↑ Vanhoenacker, Filip M., et al. "Pseudotumoural soft tissue lesions of the hand and wrist: a pictorial review." Insights into imaging 2.3 (2011): 319-333.
  10. ↑ Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 51160
  11. ↑ Novikov, A. V., M. A. Shchedrina, and S. V. Petrov. "De Quervain’s disease (etiology, pathogenesis, diagnosis and treatment). Part II." NN Priorov Journal of Traumatology and Orthopedics 26.4 (2019): 55-68.
  12. ↑ 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
  13. ↑ Harvey FJ, Harvey PM, Horsley MW. De Quervain’s disease: surgical or nonsurgical treatment. J Hand Surg. 1990;15A:83–7.
  14. ↑ Chongkriengkrai, Tanach, et al. "Effectiveness of high-intensity laser application combined with splinting and therapeutic exercise in subacute de Quervain’s tenosynovitis: A pilot study." Lasers in Medical Science 38.1 (2023): 229.
  15. ↑ 15.0 15.1 Herring, Stanley A. "The team physician and return-to-play issues: a consensus statement." Medicine & Science in Sports & Exercise 34.7 (2002): 1212-1214.
  16. ↑ Chong, Han Hong, et al. "Advancements in de Quervain tenosynovitis management: a comprehensive network meta-analysis." The Journal of Hand Surgery 49.6 (2024): 557-569.
  17. ↑ Chongkriengkrai, Tanach, et al. "Effectiveness of high-intensity laser application combined with splinting and therapeutic exercise in subacute de Quervain’s tenosynovitis: A pilot study." Lasers in Medical Science 38.1 (2023): 229.
  18. ↑ Challoumas, Dimitris, et al. "Management of de Quervain tenosynovitis: a systematic review and network meta-analysis." JAMA Network Open 6.10 (2023): e2337001-e2337001.
Created by:
John Kiel on 11 June 2019 01:53:32
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Last edited:
16 October 2025 19:38:36
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