de Quervain's tenosynovitis (stenosing tenosynovitis)
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Introduction
Overuse syndrome involving the extensor & abductor tendons of the thumb.
Etiology
- repetitive use or overuse of the hands
- association with rheumatoid arthritis
- association with pregnancy
Epidemiology
- more common in women, M:F ratio = 1:10
- generally occurs age 30-50
- especially in women in postpartum period[5]
- seen in occupations: clerical, assembly
Pathology
- stenosing tenosynovitis of the 1st dorsal retinacular compartment of the wrist involving tendons of the:
- extensor pollicis brevis
- abductor pollicis longus
Clinical manifestations
- pain over the styloid process of the radius
- pain in the anatomical snuff box or radial aspect of wrist
- pain may radiate down the thumb & up the lateral forearm
- pain occurs with use of the thumb
- pain intensified by ulnar flexion of the wrist with thumb folded into the palm & fingers flexed over thumb (Finkelstein's sign)*
- pain on the radial side of the wrist during pinch grasping[2]
- pain with extreme extension of the extensor tendon of the thumb[2]
- swelling
- crepitation
* alternatively described as patient opens hand loosely, then grasps her thumb & uses it to deviate her hand in the ulnar direction towards the 5th finger[5]
Laboratory
- ESR is generally normal
- elevated ESR suggests other etiology
- joint aspiration
- examination under polarized light for uric acid crytals
- gram stain & culture to rule out infection etiology
Radiology
- X-ray of hand
Differential diagnosis
- scaphoid fracture
- osteoarthritis of the 1st carpometacarpal joint
- carpal tunnel syndrome
- gout
- infiltrative tenosynovitis
- radiculopathy
- compression neuropathy involving superficial branch of the radial nerve ('bracelet syndrome')
- infection
Management
- rest, splinting
- physical therapy
- NSAIDs
- glucocorticoid/local anesthetic injections
- use 20-40 mg of triamcinolone (or equivalent)
- avoid damage to tendon
- refereral to rheumatology or orthopedics for injection
- surgical repair in cases recalcitrant to medical treatment
More general terms
Additional terms
- abductor pollicis longus
- extensor pollicis brevis
- Finkelstein's sign
- joint/bursa injection (knee injection, subacromial bursa injection)
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 742
- ↑ Jump up to: 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, American College of Physicians, Philadelphia 1998, 2006, 2012
Moore JS. De Quervain's tenosynovitis. Stenosing tenosynovitis of the first dorsal compartment. J Occup Environ Med. 1997 Oct;39(10):990-1002. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9343764 - ↑ Clyman B, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Ferri's Clinical Advisor, Instant Diagnosis and Treatment, Ferri FF (ed), Mosby, Philadelphia, 2003, page 253
- ↑ Jump up to: 5.0 5.1 5.2 NEJM Knowledge+ Rheumatology
- ↑ Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. J Hand Surg Am. 2002 Mar;27(2):322-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11901392 Clinical Trial.