Physical Medicine and Rehabilitation for De Quervain Tenosynovitis

Updated: Apr 27, 2016
  • Author: Patrick M Foye, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Overview

Background

De Quervain's tenosynovitis (or de Quervain tenosynovitis) is caused by stenosing tenosynovitis of the first dorsal compartment of the wrist. The first dorsal compartment at the wrist includes the tendons of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). Patients with this condition usually report pain at the dorsolateral aspect of the wrist, with referral of pain toward the thumb and/or the lateral forearm. This condition responds well to nonsurgical treatment. [1, 2, 3, 4, 5, 6] See the images below.

The first dorsal compartment of the wrist includes 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 pa 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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Pathophysiology

In the first dorsal compartment of the wrist, a tendon sheath encloses the abductor pollicis longus and the extensor pollicis brevis tendons at the lateral border of the anatomical snuffbox. Inflammation at this site commonly is seen in patients who use their hands and thumbs in a repetitive fashion. Thus, de Quervain tenosynovitis can result from cumulative (repetitive) microtrauma. Inflammation also may occur after an isolated episode of acute trauma to the site. [6]

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Epidemiology

Frequency

United States

de Quervain tenosynovitis is relatively prevalent, especially among individuals who perform repetitive activities using their hands (eg, certain assembly line workers, secretaries). [7]

Mortality/Morbidity

Mortality is not associated with de Quervain tenosynovitis. Some morbidity may result as the patient experiences progressive pain, with limitations occurring in activities requiring use of the affected hand.

Race

Traditionally, no race predilection has been reported for de Quervain tenosynovitis. However, recently the University of Colorado School of Medicine has described the black race as a risk factor for de Quervain tenosynovitis. [7]

Sex

Although this condition is commonly seen in females and males, the incidence of de Quervain tenosynovitis appears to be significantly greater in women. [6] Some sources even quote a female-to-male ratio as high as 8:1. Interestingly, many women suffer from de Quervain tenosynovitis during pregnancy or the postpartum period. [8]

Age

De Quervain's tenosynovitis is much more common in adults than in children.

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