De Quervain tenosynovitis
- Tenosynovitis of abductor pollicis longus (APL), extensor pollicis brevis (EPB)
- Groove of radial styloid
- First extensor compartment
- Middle-aged, more common in women
- Associated with rheumatoid arthritis, SLE
- Overuse of the thumb
- Classically mothers that frequently lift infants
- Or secretarial, nursing occupations
- Recently, over-texting on phones has increasingly been the culprit
- Pain along radial aspect of wrist (may radiate to thumb or extend into the forearm)
- Painful abduction of thumb
- Decreased grip strength
- Swelling at tendon sheath along radial styloid
- Positive Eichoff test
- Patient grasps thumb in palm of the hand and ulnar deviates the thumb and hand
- Stretches the tendons over the radial styloid producing sharp pain
- Positive Finkelstein's test
- Practitioner grabs thumb and sharply ulnarly deviates, causing sharp pain
- Done appropriately, produces less false positives than Eichoff test
- Negative Phalen and Tinel test
- Distal finger
- Other finger/thumb
- ESR usually normal
- Consider arthrocentesis for joint effusion to evaluate for crystals, gram stain, culture
- Plain films usually nondiagnostic
- May see soft tissue swelling or radial styloid sclerosis or erosion
- Important to rule out fracture, gas formation, late osteomyelitis
- US diagnostic
- Thickened extensor retinaculum (>0.45mm) overlying radial styloid
- Thickened APL and EPB under extensor retinaculum, as contrasted with unaffected wrist
- Edema surrounding tendons within first dorsal wrist compartment
- Surrounding hyperemia on Doppler within peritendinous subcutaneous area
- Intertendinous septum (hypoechoic area between EPB and APL) increases need for operative management
- Splint thumb and wrist
- Instruct patient to remove splint briefly each day to perform range-of-motion exercises
- NSAIDs for 10-14 days
- Persistent cases may require steroid injection or surgical decompression
- First steroid injection provides permanent relief in ~50%
- Intertendinous septum presence increases likelihood of needing surgery
- Rheumatology referral for joint injections and conservative treatment
- Hand surgery outpatient referral for failed conservative management
- Radiograph-Negative Hand and Finger Injuries
- See Dr. Nabil Ebraheim's video on dorsal wrist compartment syndromes
- Ashurst JV et al. Tenosynovitis Caused by Texting: An Emerging Disease. The Journal of the American Osteopathic Association, May 2010, Vol. 110, 294-296.
- Keon-Cohen B. De Quervain disease. J Bone Joint Surg Br. 1951;33-B(1):96-99 http://www.jbjs.org.uk/cgi/reprint/33-B/1/96.
- Ilyas A, Ast M, Schaffer AA, Thoder J (2007). De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 15 (12): 757–64.
- Ferri FF. Ferri's CLinical Advisor 2013. Elsevier Health Sciences, Jun 1, 2012.
- Kamel M, Moghazy K, Eid H, Mansour R. Ultrasonographic diagnosis of de Quervain tenosynovitis. Ann Rheum Dis. 2002;61(11):1034-1035. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753934/pdf/v061p01034.pdf.
- Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain's disease. J Orthop Sci. 2014, PMID: 24132793
- Kwon BC et al. Sonographic Identification of the Intracompartmental Septum in de Quervain’s Disease. Clin Orthop Relat Res. 2010 Aug; 468(8): 2129–2134.
- Pagonis T, Ditsios K, Toli P, Givissis P, Christodoulou A. Improved corticosteroid treatment of recalcitrant de Quervain tenosynovitis with a novel 4-point injection technique. Am J Sports Med. 2011 Feb. 39(2):398-403.
- Stephens MB. Musculoskeletal Injections: A Review of the Evidence. Am Fam Physician. 2008 Oct 15;78(8):971-976.
- Stoller DW, Tirman PF, Bredella MA. Diagnostic imaging, Orthopaedics. Amirsys Inc. (2004) ISBN:0721629202.