We need you! See something you could improve? Make an edit and help improve WikSM for everyone.
De Quervains Tenosynovitis
From WikiSM
Contents
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
- 1st Dorsal Compartment[1]
- Contains: Abductor Pollicis Longus (APL), Extensor Pollicis Brevis (EPB)
Risk Factors
- Demographic
- Female > Male
- Middle Age
- Occupational risk factors
- Mothers and childcare workers
- Secretarial occupations
- Nursing
Differential Diagnosis
DDx Finger and Hand Pain
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
DDx Wrist Pain
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
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
- Finkelsteins Test: is positive (pain with passive ulnar deviation)
- Eichhoffs Test: Also typically positive
- WHAT Test: Wrist Hyperflexion and Abduction of the Thumb
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
- Standard Radiographs Wrist, Standard Radiographs Hand
- Standard for screening, may identify other etiology of symptoms
- Typically normal
- Can show soft tissue swelling, periosteal reaction
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
- Chronic pain syndrome
- Superficial radial nerve injury
- Subluxation
- Neuroma
- Complex Regional Pain Syndrome
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ 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.
- ↑ Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 51160
- ↑ 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
- ↑ 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:
16 October 2022 00:19:30
Categories: