De Quervain Tenosynovitis

Author: Roy A Meals, MD; Chief Editor: Harris Gellman, MD more...

Updated: Apr 14, 2011

What would you like to print?

History of the Procedure
Problem
Epidemiology
Etiology
Presentation
Relevant Anatomy
Show All

History of the Procedure

In 1895, a Swiss surgeon, Fritz de Quervain, published 5 case reports of patients with a tender, thickened first dorsal compartment at the wrist.^{[1, 2, 3, 4]}The condition has subsequently borne his name, De Quervain tenosynovitis.

Problem

De Quervain tenosynovitis is an entrapment tendinitis of the tendons contained within the first dorsal compartment at the wrist; it causes pain during thumb motion.

Frequency

The most common entrapment tendinitis of the hand and wrist is trigger digit,^[5]followed by de Quervain tenosynovitis, although the latter occurs approximately one twentieth as often as does trigger digit.

Etiology

The tendons of the abductor pollicis longus and the extensor pollicis brevis are tightly secured against the radial styloid by the overlying extensor retinaculum. Any thickening of the tendons from acute or repetitive trauma restrains gliding of the tendons through the sheath. Efforts at thumb motion, especially when combined with radial or ulnar deviation of the wrist, cause pain and perpetuate the inflammation and swelling.

Presentation

Patients with De Quervain tenosynovitis note pain resulting from thumb and wrist motion, along with tenderness and thickening at the radial styloid. Crepitation or actual triggering is rarely noted. Patients frequently are mothers of infants aged 6-12 months, and symptoms are often noted in both wrists. Repetitive lifting of the baby as it grows heavier is responsible for friction tendinitis. Day care workers and other persons who repetitively lift infants are frequently affected as well. De Quervain tenosynovitis can also develop in individuals who have sustained a direct blow to the area of the first dorsal compartment.

Examination

The first dorsal compartment over the radial styloid becomes thickened and feels bone hard; the area becomes tender. Usually, the compartment's thickening so distorts the sparsely padded skin in this area that a visible fusiform mass is created (see image below).

In de Quervain tenosynovitis, the first dorsal compartment is thickened, raising the skin and creating a prominence at the radial styloid.

The Finkelstein test (consisting of flexion of the thumb across the palm and then ulnar deviation of the wrist) causes sharp pain at the first dorsal compartment (see image below).^[6]

The Finkelstein test draws the tendons of the first dorsal compartment distally and causes sharp, local pain when tendon entrapment has occurred and inflammation is present.

Tenderness is absent over the muscle bellies proximal to the first dorsal compartment. Tenderness and pain on axial loading are absent at the carpometacarpal (CMC) joint unless the patient has arthritis in that joint.

For excellent patient education resources, visit eMedicine's Arthritis Center. Also, see eMedicine's patient education article Tendinitis.

Relevant Anatomy

The tendons of the abductor pollicis longus and the extensor pollicis brevis pass through the first dorsal compartment. The abductor pollicis longus tendon is usually multistranded. The extensor pollicis brevis tendon is typically much smaller than even a single slip of the abductor pollicis longus tendon, and it may be congenitally absent. A septum separating the first dorsal compartment into distinct subcompartments for the abductor pollicis longus tendons and the extensor pollicis brevis tendon is often noted at surgery.^[7]

Proceed to Workup

Contributor Information and Disclosures

Author

Roy A Meals, MD Clinical Professor, Department of Orthopedic Surgery, University of California at Los Angeles

Roy A Meals, MD is a member of the following medical societies: American Society for Surgery of the Hand

Disclosure: George Tiemann Company Royalty Other

Specialty Editor Board

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Michael Yaszemski, MD, PhD Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

DeQuervain F. Ueber eine Form von chronischer Tendovaginitis. Corresp Blatt Schweizer Arzte. 1895;25:389-94.
de Quervain F. On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895. Am J Orthop. Sep 1997;26(9):641-4. [Medline].
de Quervain F. On the nature and treatment of stenosing tendovaginitis on the styloid process of the radius. (Translated article: Muenchener Medizinische Wochenschrift 1912, 59, 5-6). J Hand Surg [Br]. Aug 2005;30(4):392-4. [Medline].
de Quervain F. On a form of chronic tendovaginitis. (Translated article: Cor-Bl.f.schweiz. Aerzrte 1895:25:389-94). J Hand Surg [Br]. Aug 2005;30(4):388-91. [Medline].
Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, et al. Sonographic appearance of trigger fingers. J Ultrasound Med. Oct 2008;27(10):1407-13. [Medline].
Finkelstein H. Stenosing tendovaginitis at the radial styloid process. Journal of Bone and Joint Surgery. 1930;12:509-40.
Kulthanan T, Chareonwat B. Variations in abductor pollicis longus and extensor pollicis brevis tendons in the Quervain syndrome: a surgical and anatomical study. Scand J Plast Reconstr Surg Hand Surg. 2007;41(1):36-8. [Medline].
Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J Hand Surg [Am]. Jul 1994;19(4):595-8. [Medline].
Stephens MB, Beutler AI, O'Connor FG. Musculoskeletal injections: a review of the evidence. Am Fam Physician. Oct 15 2008;78(8):971-6. [Medline].
Diop AN, Ba-Diop S, Sane JC, Tomolet Alfidja A, Sy MH, Boyer L, et al. [Role of US in the management of de Quervain's tenosynovitis: review of 22 cases]. J Radiol. Sep 2008;89(9 Pt 1):1081-4. [Medline].
Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. Apr 2007;31(2):265-8. [Medline].
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. Feb 2011;39(2):398-403. [Medline].
Scheller A, Schuh R, Hönle W, Schuh A. Long-term results of surgical release of de Quervain's stenosing tenosynovitis. Int Orthop. Oct 28 2008;[Medline].
Jackson WT, Viegas SF, Coon TM. Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study. J Bone Joint Surg [Am]. Jul 1986;68(6):923-6. [Medline].
Dierks U, Hoffmann R, Meek MF. Open versus percutaneous release of the A1-pulley for stenosing tendovaginitis: a prospective randomized trial. Tech Hand Up Extrem Surg. Sep 2008;12(3):183-7. [Medline].
Louis DS. Incomplete release of the first dorsal compartment--a diagnostic test. J Hand Surg [Am]. Jan 1987;12(1):87-8. [Medline].
Arons MS. de Quervain's release in working women: a report of failures, complications, and associated diagnoses. J Hand Surg [Am]. Jul 1987;12(4):540-4. [Medline].
McMahon M, Craig SM, Posner MA. Tendon subluxation after de Quervain's release: treatment by brachioradialis tendon flap. J Hand Surg [Am]. Jan 1991;16(1):30-2. [Medline].
Cannon DE, Dillingham TR, Miao H, et al. Musculoskeletal disorders in referrals for suspected cervical radiculopathy. Arch Phys Med Rehabil. Oct 2007;88(10):1256-9. [Medline].
Linscheid RL. Injuries to radial nerve at wrist. Arch Surg. Dec 1965;91(6):942-6. [Medline].