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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


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


  • Named after Swiss surgeon Fritz De Quervain


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



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


  • 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

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.[3]


  • 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


Short axis view of De Quervain's. Thickening of tendon, hypoechoic fluid surrounds the EPB tendon. Note the difference compared to APL.[4]



  • 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


  • 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


  • Not applicable



  • 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[5]
    • Harvey et al found an 80% success rate among 71 cases[6]
    • Use of ultrasound is recommended if possible, although not required
  • Thumb Spica Splint
  • Physical Therapy


  • 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


  • Needs to be updated

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis


  • Needs to be updated


See Also




  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. 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.
  4. Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 51160
  5. 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
  6. 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
Last edited:
30 April 2024 23:41:09