De Quervain’s Tenosynovitis
Stenosing tenosynovitis of the <strong>first dorsal compartment</strong>, affecting <strong>abductor pollicis longus (APL)</strong> and <strong>extensor pollicis brevis (EPB)</strong> at the radial styloid. Inflammation is part of the acute picture, but chronic cases become fibrotic and stenotic.
Mechanism and risk
- Repetitive thumb abduction or extension with ulnar wrist deviation
- Direct trauma to the radial wrist, or inflammatory arthropathy
- Postpartum: hormonal change plus infant lifting (“mommy thumb”). Also “gamer’s thumb” and smartphone overuse.
- Other groups: racquet sports, golf, rowing, canoeing, climbing, carpentry, tailoring
- Risk factors: female sex (3 to 10 times more common), age 30 to 50, pregnancy, rheumatoid arthritis, diabetes
- Anatomy: septation of the first dorsal compartment (a separate EPB sub-sheath, in about 40%) is linked to treatment failure.
Presentation
- Pain and swelling over the radial styloid, may radiate to the thumb or forearm
- Provoked by thumb movement, gripping, pinching, wringing
- Focal tenderness and fusiform swelling over the first dorsal compartment, sometimes crepitus
| Test | Method |
|---|---|
| Finkelstein | Thumb enclosed in the fist, wrist deviated ulnarly |
| Eichhoff | Similar, thumb held in extension. Often what is actually performed as “Finkelstein” |
Both can give false positives.
Differential
scaphoid fracture, thumb CMC osteoarthritis, intersection syndrome, radial sensory nerve entrapment.
Always consider scaphoid fracture in acute radial wrist pain after trauma. A missed fracture is a serious medico-legal risk.
Management
- Thumb spica splint and activity modification: first-line, especially in pregnancy and the postpartum period. Many resolve after delivery.
- NSAIDs: symptomatic. Hand therapy: adjunct.
- Corticosteroid injection into the first dorsal compartment: the mainstay and one of the most reliably effective injections in musculoskeletal medicine. About 70 to 80% respond, often after one injection, so it is a reasonable early option.
- Surgical release: cases failing splinting, NSAIDs and 1 to 2 injections, or with anatomical septation. A day-case procedure under local anaesthesia, reserved for cases that fail conservative care.
References
- Common Hand Conditions: A Review, JAMA 2022, doi:10.1001/jama.2022.8481
- Tendinopathies of the Hand and Wrist, J Am Acad Orthop Surg 2015, doi:10.5435/jaaos-d-14-00216
Related
Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.