Physical Medicine and Rehabilitation for De Quervain Tenosynovitis Workup

  • Author: Patrick M Foye, MD; Chief Editor: Rene Cailliet, MD   more...
 
Updated: Nov 2, 2010
 

Laboratory Studies

No laboratory studies support the diagnosis of de Quervain tenosynovitis. The clinician may consider serologic testing for rheumatoid arthritis (ie, checking serum rheumatoid factor) if the patient has no history of either acute or repetitive trauma or other risk factors.

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Imaging Studies

As a rule, no imaging studies are required for diagnosing de Quervain tenosynovitis.

If a sufficient history of acute trauma exists, radiographs of the wrist are indicated to assess for fracture.

If the radiographs are negative but there is nonetheless a suggestion of fracture or osteonecrosis, further imaging studies can be pursued (eg, 3-phase bone scan). Triple-phase scintigraphy includes the following:

  • Phase 1 - Flow phase (radionuclide angiography)
  • Phase 2 - Blood pool phase (soft-tissue scintigraphy)
  • Phase 3 - Late phase (skeletal bone scintigraphy)

After a fracture, increased flow and pooling may be seen in phases 1 and 2, but these findings are due only to local inflammation, which is not specific for fracture. Thus, increased uptake in phase 3 is the most important feature for diagnosis of a fracture, and this indicator may remain positive for months.

For fracture at the scaphoid, the 3-phase bone scan is believed to have a sensitivity of 100%, and many research studies use this test as the criterion standard for diagnosis of de Quervain tenosynovitis; in clinical practice, however, bone scanning is needed only if the plain radiographs are negative.

Increased thickness of the extensor pollicus brevis and abductor pollicus longus are the most reliable indications on a MRI scan of the wrist that de Quervain tenosynovitis is present.[13]

A study showed that the presence of an intracompartmental septum, which divides the first extensor compartment, can negatively affect the outcomes of corticosteroid injections.[14] The septum may impair through spread of the injectate throughout the entire first dorsal compartment. The study suggests that the presence of this septum may be a risk factor for de Quervain tenosynovitis, and that ultrasonography can nonsurgically detect this septum. Further research may be necessary to elucidate whether visualization of the septum using ultrasonography can then be used as a predictor as to the prognosis of an injection as a treatment or whether ultrasonographic guidance can overcome any outcome obstacles posed by the septum.

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Procedures

No other diagnostic procedures are needed in most cases of de Quervain tenosynovitis.

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Contributor Information and Disclosures
Author

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD  Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine

Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Dev Sinha, MD  Research Associate/Physiatrist Observership, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert L Sheridan, MD  Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School

Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Richard Salcido, MD  Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD  Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center

Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association

Disclosure: Nothing to disclose.

References

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  2. Brinker MR, Miller MD. The adult wrist. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:179-95.

  3. McGee DJ. Forearm, wrist, and hand. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:198-215.

  4. Snider RK. Hand and wrist. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:160-263.

  5. Strakowski JA, Wiand JW, Johnson EW. Upper limb musculoskeletal pain syndromes. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:756-82.

  6. Ilyas AM, Ast M, Schaffer AA, et al. De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. Dec 2007;15(12):757-64. [Medline].

  7. Wolf JM, Sturdivant RX, Owens BD. Incidence of de Quervain's tenosynovitis in a young, active population. J Hand Surg Am. Jan 2009;34(1):112-5. [Medline].

  8. Wolf JM, Sturdivant RX, Owens BD. Incidence of de Quervain's tenosynovitis in a young, active population. J Hand Surg Am. Jan 2009;34(1):112-5. [Medline].

  9. Schned ES. DeQuervain tenosynovitis in pregnant and postpartum women. Obstet Gynecol. Sep 1986;68(3):411-4. [Medline].

  10. Forget N, Piotte F, Arsenault J, et al. Bilateral thumb's active range of motion and strength in de Quervain's disease: comparison with a normal sample. J Hand Ther. Jul-Sep 2008;21(3):276-84; quiz 285. [Medline].

  11. Batteson R, Hammond A, Burke F, et al. The de Quervain's screening tool: validity and reliability of a measure to support clinical diagnosis and management. Musculoskeletal Care. Sep 2008;6(3):168-80. [Medline].

  12. Hanlon DP, Luellen JR. Intersection syndrome: a case report and review of the literature. J Emerg Med. Nov-Dec 1999;17(6):969-71. [Medline].

  13. Glajchen N, Schweitzer M. MRI features in de Quervain's tenosynovitis of the wrist. Skeletal Radiol. Jan 1996;25(1):63-5. [Medline].

  14. Kwon BC, Choi SJ, Koh SH, Shin DJ, Baek GH. Sonographic Identification of the intracompartmental septum in de Quervain's disease. Clin Orthop Relat Res. Aug 2010;468(8):2129-34. [Medline].

  15. Diop AN, Ba-Diop S, Sane JC, 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].

  16. Lennard TA. Fundamentals of procedural care. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.

  17. Robson AJ, See MS, Ellis H. Applied anatomy of the superficial branch of the radial nerve. Clin Anat. Jan 2008;21(1):38-45. [Medline].

  18. Scheller A, Schuh R, Honle W, et al. Long-term results of surgical release of de Quervain's stenosing tenosynovitis. Int Orthop. Oct 2009;33(5):1301-3. [Medline].

  19. Richie CA 3rd, Briner WW Jr. Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract. Mar-Apr 2003;16(2):102-6. [Medline]. [Full Text].

  20. Geiringer SR. Tendon sheath and insertion injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:44-8.

  21. Goldfarb CA, Gelberman RH, McKeon K, et al. Extra-articular steroid injection: early patient response and the incidence of flare reaction. J Hand Surg [Am]. Dec 2007;32(10):1513-20. [Medline].

  22. 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]. [Full Text].

  23. Apimonbutr P, Budhraja N. Suprafibrous injection with corticosteroid in de Quervain's disease. J Med Assoc Thai. Mar 2003;86(3):232-7. [Medline].

  24. Jeyapalan K, Choudhary S. Ultrasound-guided injection of triamcinolone and bupivacaine in the management of De Quervain's disease. Skeletal Radiol. Nov 2009;38(11):1099-103. [Medline].

  25. Venkatesan P, Fangman WL. Linear hypopigmentation and cutaneous atrophy following intra-articular steroid injections for de Quervain's tendonitis. J Drugs Dermatol. May 2009;8(5):492-3. [Medline].

  26. Chodoroff G, Honet JC. Cheiralgia paresthetica and linear atrophy as a complication of local steroid injection. Arch Phys Med Rehabil. Sep 1985;66(9):637-9. [Medline].

  27. Green SM. Nonsteroidal anti-inflammatories. In: Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Pub; 2000:2000:11-2.

 
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The first dorsal compartment of the wrist includes the tendon sheath that encloses the abductor pollicis longus and the extensor pollicis brevis tendons at the lateral border of the anatomic snuffbox.
The Finkelstein test is performed by having the patient make a fist with the thumb inside the fingers. The clinician then applies ulnar deviation of the wrist to reproduce the presenting symptoms of dorsolateral wrist pain.
 
 
 
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