DeQuervain Tenosynovitis

Ovid: 5-Minute Sports Medicine Consult, The

DeQuervain Tenosynovitis
William W. Briner Jr
  • de Quervain tenosynovitis is a stenosing tendinosis of the 1st dorsal compartment of the wrist.
  • The abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons course through this compartment.
  • It is the most frequently encountered tendinosis on the dorsal side of the wrist.
  • de Quervain tenosynovitis is typically an overuse injury, but may result from direct trauma.
  • Synonym(s): Extensor tendonitis; Stenosing tenosynovitis; Stenosing tendinitis; Peritendinitis; Styloid tenovaginitis; Stenosing tendovaginitis
  • Usually seen in adults aged 30–50 yrs
  • More common in females than males
Risk Factors
  • Activities requiring forceful grasp with excessive ulnar wrist deviation or repetitive use of the thumb (eg, golfing, bowling, wrestling, fly fishing, racquet sports [squash, badminton, tennis], javelin or discus throwing)
  • Direct trauma with associated scarring
  • Also can be seen as systemic component of rheumatologic disorders such as rheumatoid arthritis
  • Repetitive or sustained tension on tendons of the 1st dorsal compartment cause an inflammatory, then fibroblastic response.
  • There is thickening and swelling of the extensor tendons and retinaculum.
  • Pain is produced from resisted gliding of the APL and EPB tendons in the narrowed fibroosseous canal.
  • Histopathology is consistent with collagen disorientation and mucoid changes (tendinosis), not inflammation.
  • Gradual onset of pain along the radial styloid of the wrist for several weeks to months
  • Acute onset of pain over the radial styloid after trauma
  • Pain is aggravated by moving the wrist or thumb.
  • Pain may radiate to the thumb, up the dorsoradial aspect of the forearm, or occasionally into the shoulder.
Physical Exam
  • Swelling, tenderness, and/or crepitus to palpation of the APL and EPB tendons near the radial styloid process
  • Positive Finkelstein test is pathognomonic and confirms the diagnosis.
  • To perform the Finkelstein test, the examining physician grasps the thumb of the patient and the hand is ulnar-deviated sharply. A positive test produces sharp pain along the distal radius.
  • A similar test was previously described by Eichoff, in which the thumb is placed in the palm of the hand and held with the fingers; the hand is then ulnar-deviated, causing intense pain over the radial styloid. (This test is often confused with the Finkelstein test.)
  • Uncommon presentations include extensor triggering or locking of the thumb and dorsal ganglion cyst formation.
Diagnostic Tests & Interpretation
  • Usually none needed
  • If patient has history of trauma or other bone pathology is suspected, obtain wrist x-rays.
  • US and US-guided injection may help confirm the diagnosis, identify anatomical variants, and ensure proper placement of medication, which may increase efficacy and decrease complications and possibly recurrences.
Differential Diagnosis
  • Trigger thumb
  • Thumb carpometacarpal joint arthritis
  • Intersection syndrome
  • Flexor carpi radialis tendonitis
  • Radial styloid fracture
  • Scaphoid fracture
  • Avascular necrosis of the scaphoid
  • Radial neuritis
  • Wartenburg's syndrome


Ongoing Care
727.04 Radial styloid tenosynovitis

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