Physical Medicine and Rehabilitation for De Quervain Tenosynovitis Workup
- Author: Patrick M Foye, MD; Chief Editor: Stephen Kishner, MD, MHA more...
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.
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.
A study showed that the presence of an intracompartmental septum, which divides the first extensor compartment, can negatively affect the outcomes of corticosteroid injections. 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. For example, a recent study used ultrasound guidance to determine the presence or absence of a septum within the first dorsal compartment. If a septum was present, half of the injectate was administered, then the septum was pierced by the needle and the other half of the injectate wasthen administered on the other side of the septum.
No other diagnostic procedures are needed in most cases of de Quervain tenosynovitis.
Breen TF. Wrist and hand. Steinberg GG, Akins CM, Baran DT. Orthopaedics in Primary Care. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999. 99-138.
Brinker MR, Miller MD. The adult wrist. Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999. 179-95.
McGee DJ. Forearm, wrist, and hand. Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992. 198-215.
Snider RK. Hand and wrist. Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997. 160-263.
Strakowski JA, Wiand JW, Johnson EW. Upper limb musculoskeletal pain syndromes. Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996. 756-82.
Ilyas AM, Ast M, Schaffer AA, et al. De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 2007 Dec. 15(12):757-64. [Medline].
Wolf JM, Sturdivant RX, Owens BD. Incidence of de Quervain's tenosynovitis in a young, active population. J Hand Surg Am. 2009 Jan. 34(1):112-5. [Medline].
Schned ES. DeQuervain tenosynovitis in pregnant and postpartum women. Obstet Gynecol. 1986 Sep. 68(3):411-4. [Medline].
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. 2008 Jul-Sep. 21(3):276-84; quiz 285. [Medline].
Goubau JF, Goubau L, Van Tongel A, Van Hoonacker P, Kerckhove D, Berghs B. The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff's Test. J Hand Surg Eur Vol. 2014 Mar. 39(3):286-92. [Medline].
Lutsky K, Kim N, Medina J, Maltenfort M, Beredjiklian PK. Hand Dominance and Common Hand Conditions. Orthopedics. 2016 Mar 17. 1-5. [Medline].
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. 2008 Sep. 6(3):168-80. [Medline].
Hanlon DP, Luellen JR. Intersection syndrome: a case report and review of the literature. J Emerg Med. 1999 Nov-Dec. 17(6):969-71. [Medline].
Glajchen N, Schweitzer M. MRI features in de Quervain's tenosynovitis of the wrist. Skeletal Radiol. 1996 Jan. 25(1):63-5. [Medline].
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. 2010 Aug. 468(8):2129-34. [Medline].
McDermott JD, Ilyas AM, Nazarian LN, Keinberry CF. Ultrasound-guided injections for de Quervain’s tenosynovitis. Clin Orthop Relat Res. Jul 2012. 470(7):1925-31. [Medline].
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. 2008 Sep. 89(9 Pt 1):1081-4. [Medline].
Lennard TA. Fundamentals of procedural care. Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995. 1-13.
Robson AJ, See MS, Ellis H. Applied anatomy of the superficial branch of the radial nerve. Clin Anat. 2008 Jan. 21(1):38-45. [Medline].
Scheller A, Schuh R, Honle W, et al. Long-term results of surgical release of de Quervain's stenosing tenosynovitis. Int Orthop. 2009 Oct. 33(5):1301-3. [Medline].
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. 2003 Mar-Apr. 16(2):102-6. [Medline]. [Full Text].
Mehdinasab SA, Alemohammad SA. Methylprednisolone acetate injection plus casting versus casting alone for the treatment of de Quervain’s tenosynovitis. Arch Iran Med. Jul 2010. 13(4):270-4. [Medline].
Geiringer SR. Tendon sheath and insertion injections. Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995. 44-8.
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]. 2007 Dec. 32(10):1513-20. [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].
Apimonbutr P, Budhraja N. Suprafibrous injection with corticosteroid in de Quervain's disease. J Med Assoc Thai. 2003 Mar. 86(3):232-7. [Medline].
Jeyapalan K, Choudhary S. Ultrasound-guided injection of triamcinolone and bupivacaine in the management of De Quervain's disease. Skeletal Radiol. 2009 Nov. 38(11):1099-103. [Medline].
Venkatesan P, Fangman WL. Linear hypopigmentation and cutaneous atrophy following intra-articular steroid injections for de Quervain's tendonitis. J Drugs Dermatol. 2009 May. 8(5):492-3. [Medline].
Chodoroff G, Honet JC. Cheiralgia paresthetica and linear atrophy as a complication of local steroid injection. Arch Phys Med Rehabil. 1985 Sep. 66(9):637-9. [Medline].
Green SM. Nonsteroidal anti-inflammatories. Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Pub; 2000. 2000:11-2.
Cavaleri R, Schabrun SM, Te M, Chipchase LS. Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: a systematic review and meta-analysis. J Hand Ther. 2016 Jan-Mar. 29 (1):3-11. [Medline].