Wrist
De Quervain's Tenosynovitis
드퀘르벵 건초염
Stenosing tenosynovitis of APL and EPB tendons at 1st dorsal compartment — radial wrist pain at thumb base
- How common
- Common
- Typical age
- Ages 30–50
What is it?
Stenosing inflammation of APL and EPB tendon sheaths within the first dorsal compartment
Commonly affected: 1st dorsal compartment: APL (abductor pollicis longus) and EPB (extensor pollicis brevis) tendon sheaths
How it develops
- Overuse InjuryRepetitive thumb use (baby holding, smartphone use, instrument playing) increases APL/EPB tendon sheath friction
- Sheath ThickeningRepetitive friction causes reduced sheath lubrication and fibrous thickening
- Stenosing TenosynovitisDifficulty of tendon passage through sheath → radial wrist pain and dysfunction
- Pain and Functional LimitationPain with thumb extension and abduction, weak pinch grip
Symptoms
- Positive Finkelstein'sRadial styloid pain reproduced by grasping thumb in palm and ulnar deviating wrist
- Radial Styloid PainRadial wrist pain at thumb base (radial styloid area) — may radiate up radial forearm
- Weak Pinch GripPainful weakness with thumb use (jar opening, scissors)
- Local SwellingMild swelling and tenderness around radial styloid
How it is examined
- Finkelstein's TestTuck thumb inside fist, then ulnar deviate wrist → reproduces radial styloid pain → Positive (most important test)
- Differentiation from Lateral EpicondylitisNo lateral epicondyle tenderness — differentiates from lateral epicondylitis. Specific APL/EPB area tenderness
- Resisted Thumb Abduction/ExtensionPain and weakness with resisted thumb abduction and extension
Imaging
Usually normal. Exclude secondary causes (arthritis, fracture)
- Usually normal
- Periradial styloid changes (rarely)
- 1st CMC joint arthritis (basal joint) may coexist
Confirm tendon sheath thickening and effusion, exclude secondary causes
- APL/EPB tendon sheath thickening and effusion
- Peritendinous T2 hyperintensity
- First dorsal compartment stenosis
Non-surgical care
- Thumb Spica SplintWrist splint including thumb base (thumb spica) — stabilizes tendons by immobilizing thumb and wrist
- Steroid InjectionSteroid injection into 1st dorsal compartment — 70-80% short-term success
- NSAIDs and IcingAnti-inflammatory medication and local icing for symptom relief
- Activity ModificationAvoid thumb/wrist-provoking activities. Adjust breastfeeding posture (new mothers)
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed conservative treatment 3-6 months (>2 steroid injections ineffective)
Procedures that may be discussed
- 1st dorsal compartment release
- Identify and release subsheath if present
Outlook
80-90% improvement with conservative treatment (especially steroid injection). Postpartum cases have high chance of spontaneous resolution