De Quervain's Tenosynovitis
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Clinically Relevant Anatomy
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De Quervain's tenosynovitis involves the abductor pollicis longus and the extensor pollicis brevis tendons. Both muscles and tendons extend the thumb backwards or move the thumb away from the palm, radial abduction. These tendons perform similar movement and run from the forearm to the thumb.
Mechanism of Injury / Pathological Process
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Usually caused by a new repetitive activity such as gardening, knitting, racket sports, or work tasks. In the technology age is has been nicknamed “Blackberry Thumb”1
Clinical Presentation[edit | edit source]
DeQuervains occurs in women 8-10 times more often than men.2 The condition can be sudden or gradual. Presents most commonly with pain and/or swelling on the radial side of the wrist at the base of the thumb (first dorsal compartment). Symptoms increase with pinching, grasping, and gripping activities. Pain at the thumb and wrist can progress up the forearm. New mothers are prone to this due to child care tasks with lifting, holding and feeding placing the hand in awkward positions; as well as hormonal changes.3
Diagnostic Procedures[edit | edit source]
Finkelstein test
Management / Interventions
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Non Operative:
Rest: activity modification and use of brace/splint for the thumb and wrist.
Anti-inflammatory: oral medication, phonophoresis, inotophoresis, or cold packs.
Injection: steroid
Surgery:
The sheath of the first dorsal compartment is opened longitudinally for decompression.
Differential Diagnosis
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1. Osteoarthritis of the first CMC joint1,4
2. Intersection syndrome – pain will be more towards the middle of the back of the forearm and about 2-3 inches below the wrist1,4
3. Wartenberg’s Syndrome - isolated neuritis of the superficial radial nerve, can be caused by tight jewelry1,4
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