summary De Quervain's Tenosynovitis is a stenosing tenosynovial inflammation of the 1st dorsal compartment. Diagnosis is made clinically with radial sided wrist pain made worse with the Finkelstein maneuver. Treatment is generally conservative with thumb spica braces, injections and in refractory cases, 1st dorsal compartment surgical release. Epidemiology Incidence very common ~1 per 1000 annually Demographics woman > men 30 - 50 years old Anatomic location most commonly in the dominant wrist Risk factors overuse golfers and racquet sports post-traumatic postpartum Etiology Pathophysiology pathoanatomy thickening and swelling of extensor retinaculum causes increased tendon friction NOT considered an inflammatory process login to view 1 more bullet Anatomy Extensor tendon compartments Compartment 1 (De Quervain's Tenosynovitis) APL EPB Compartment 2 (Intersection syndrome ) ECRL ECRB Compartment 3 EPL Compartment 4 EIP EDC Compartment 5 (Vaughan-Jackson Syndrome ) EDM Compartment 6 (Snapping ECU ) ECU Presentation Symptoms gradual onset radial sided wrist pain pain exacerbated by gripping and raising objects with wrist in neutral Physical exam inspection tenderness over 1st dorsal compartment at level of radial styloid motion usually normal wrist motion pain with resisted radial deviation neurovascular exam normal provocative tests Finkelstein maneuver login to view 2 more bullets Eichhoff maneuver login to view 1 more bullet Imaging Radiographs recommended views AP, lateral views of wrist indications radiographs usually not indicated findings may be used to rule out login to view 2 more bullets Differential Thumb CMC arthritis Intersection syndrome FCR tendinitis Diagnosis Clinical diagnosis is made with careful history and physical examination Treatment Nonoperative rest, NSAIDS, thumb spica splint, steroid injection indications login to view 1 more bullet technique login to view 2 more bullets outcomes login to view 2 more bullets Operative surgical release of 1st dorsal compartment indications login to view 2 more bullets technique login to view 2 more bullets Techniques Surgical release of 1st dorsal compartment approach transverse incision with release on dorsal side of 1st compartment to prevent volar subluxation of the tendon login to view 3 more bullets Complications Sensory branch of radial nerve injury Neuroma formation Failure to decompress with recurrence may be caused by failure to recognize and decompress EPB or APL lying in separate subsheath/compartment Complex regional pain syndrome Prognosis Most cases resolve with non-operative management High recurrence rate