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DeQuervain Tenosynovitis

De Quervain tenosynovitis is a stenosing tendinosis of the 1st dorsal compartment of the wrist. The abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons course through this compartment. It is the most frequently encountered tendinosis on the dorsal side of the wrist.

Image shows how to do a Finkelstein Test.for DeQuervain Tenosynovitis
Original Finkelstein Test

SYMPTOMS 

  • There is localized, sometimes intense exercise-induced pain and swelling over the radial part of the wrist. This is common in racket sports.
  • These symptoms are caused by compression of the abductor pollicis longus and extensor pollicis brevis by swollen, inflamed or hypertrophied tendon sheaths.
  • There is tenderness on palpation over the radial part of the wrist and Finkelstein’s test is positive.

INVESTIGATIONS 

Ultrasound investigation or MRI show para-tendinous fluid and occasionally two separate tendon sheaths. It is important to know this if surgery is required.

Treatment
• Rest from offending activity.
• Ice massage is beneficial when used early.
• Corticosteroid injection is effective treatment
• Patient must be cautioned against overuse following an injection.
• NSAIDs may benefit some patients.
• Using a thumb spica splint may relieve pain, but there is some suggestion that immobilization could increase recovery time.


Surgery: If conservative therapy is ineffective, surgical release of the fibrous 1st dorsal compartment may be considered.