II. Epidemiology
- Most common in women 30 to 50 years old
- Also more common at 4 to 6 weeks postpartum
III. History
- First described by the swiss surgeon Fritz de Quervain in 1895
IV. Pathophysiology
- Tendon Entrapment and inflammation of the thumb extensor tendons
- Extensor pollicis brevis tendon
- Abductor pollicis longus tendon
- Occurs where tendons cross radial styloid
- First dorsal extensor compartment of the radial wrist
- Associated with overuse with repetitive wrist or thumb movement
- Variations: Extensor Carpi Radialis Tenosynovitis
- Affects radial wrist extensors
- Seen in heavy laborers
- Same signs, symptoms and management as de Quervain's
V. Risk Factors
- Pregnancy
- Repetitive motion of the thumb and wrist (e.g. hammering, knitting)
- Heavy lifting
- Rheumatoid Arthritis
- Diabetes Mellitus
VI. Findings: Signs and symptoms
- Tenderness and swelling at the radial wrist (thumb base or radial styloid)
- First dorsal extensor compartment (snuff box) symptoms
- Crepitation with extensor tendon movement
- Local thickening of tendon sheath
- Radiation of pain
- Ascending up Forearm
- Descending down into thumb
- Provocative maneuver eliciting pain
- Finkelstein Test
- Active and passive range of motion of thumb
VII. Differential Diagnosis
- See Wrist Pain
- Ganglion Cyst
- Radial Nerve entrapment at Forearm
- Wrist extensor Tendinopathy
-
Osteoarthritis
- First extensor compartment
- First Metacarpophalangeal joint Osteoarthritis
VIII. Management
- NSAIDs
- Thumb spica spint immobilization
- Avoid offending repetitive activity
- Moist heat as needed
- De Quervain's Tenosynovitis Injection
- Surgical correction: first dorsal compartment release
- Indicated for persistent symptoms despite above