De Quervain’s Tenosynovitis
Definition and Relevant Anatomy
De Quervain’s tenosynovitis is an overuse disorder affecting the tendons of the first dorsal extensor compartment of the wrist.
Involved tendons:
- Abductor pollicit slongus (APL)
- Extensor pollicits brevis (EPB)
These tendons pass together through a fibro-osseous tunnel over the radial styloid before inserting into the thumb.
Learning aid:
The tendons involved in De Quervain’s tenosynovitis are the same as those that make up the lateral border of the anatomical snuffbox.
Causes and Risk Factors
De Quervain’s tenosynovitis usually develops as a result of repetitive thumb and wrist loading, such as:
- Caring for an infant (repetitive lifting) (therefore De Quervain’s tenosynovitis is also known as “Mother’s thumb”)
- Frequent phone use
- Manual work
- Racquet sports
Risk factors include:
- Female
- 30-50 y/o
- Pregnancy and postpartum period
- Repetitive occupational or sporting activities
Less common, but rheumatoid arthritis can predispose to bilateral De Quervain’s tenosynovitis
Clinical features
Typical presentation:
- Gradual onset radial wrist pain
- Pain at the base of the thumb and over the radial styloid process
- Reduced grip strength due to pain
- Pain worsened by
- Thumb movement
- Lifting objects
- Gripping
- Pinching
- Twisting actions (e.g. opening jars)
Investigation and diagnosis
De Quervain’s tenosynovitis is primarily a clinical diagnosis
The Finkelstein test is a clinical test that can be used to help support the diagnosis
- Description: The patient places the thumb into the palm and closes the fingers over it to form a fist. The examiner then gently applies ulnar deviation (deviating the wrist downwards towards the little finger)
- Positive test finding: Reproduction of sharp pain over the radial styloid
Imaging is not routinely required
- X-ray may be used to exclude fracture or OA of the thumb
- Ultrasound may be used for diagnostic uncertainty
- MRI can be used for atypical / complex cases
Management
Most patients respond well to conservative management, involving:
- Activity modification to avoid repetitive thumb movements
- Relative rest
- Analgesia and ice for pain relief
- Thumb spica splint to immobilise the thumb and wrist
- Physiotherapy (e.g. stretching and strengthening, tendon gliding exercises) or occupational therapy
If symptoms persist despite initial conservative management, corticosteroid injection into the first dorsal extensor compartment can be considered
Surgery is a last resort and rarely required
- It is only considered if there are persistent symptoms and functional limitations despite prolonged conservative management and corticosteroid injection
- Surgical treatment would involve releasing the first dorsal extensor compartment to reduce tendon constriction