De Quervain Tenosynovitis Clinical Presentation

Updated: Aug 27, 2018
  • Author: Roy A Meals, MD; Chief Editor: Harris Gellman, MD  more...
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Presentation

History

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.

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Physical 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 the image below).

In de Quervain tenosynovitis, the first dorsal com 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 the image below). [9]

The Finkelstein test draws the tendons of the firs 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.

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