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 Finkelstein, pathognomonic
- 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
- Negative Phalen and Tinel test
- Radiograph positive
- Radiograph negative
- Boutonniere deformity
- Compressive neuropathy ("bracelet syndrome")
- De Quervain tenosynovitis
- Drummer's wrist
- Dupuytren contracture
- Extensor digitorum tenosynovitis
- Fingertip laceration
- Ganglion cyst
- Gout and Pseudogout
- Hand and finger tendon injuries
- High-pressure injection injury
- Infiltrative tenosynovitis
- Intersection syndrome
- Jammed finger
- Jersey finger
- Lunotriquetral ligament instability
- Mallet finger
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Nail avulsion
- Rheumatoid arthritis
- Scaphoid fracture
- Snapping Extensor Carpi Ulnaris
- Subungual hematoma
- Trigger finger
- Vaughn Jackson syndrome
- 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
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- Ashurst JV et al. Tenosynovitis Caused by Texting: An Emerging Disease. The Journal of the American Osteopathic Association, May 2010, Vol. 110, 294-296.
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- 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.
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