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 may be related to accumulation of mucopolysaccharides 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 On grasping the patient’s thumb and quickly abducting the hand ulnarward, the pain over the styloid tip is painful more indicative of EPB > APL tendon pathology Eichhoff maneuver ulnar deviated wrist while patient clenches thumb in fist, followed by relief of pain once the thumb is extended even if the wrist remains ulnar deviated Imaging Radiographs recommended views AP, lateral views of wrist indications radiographs usually not indicated findings may be used to rule out basilar arthritis of the thumb carpal arthritis 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 first line of treatment technique NSAIDS, rest and immobilisation usually first step steroid injections into first dorsal compartment usually second step outcomes overall corticosteriods found to be superior to splinting concomitant splinting and/or NSAIDs after steriods injection does not improve outcomes Operative surgical release of 1st dorsal compartment indications severe symptoms usually consider after 6 months of failed nonoperative management technique radial based incision proximal to the wrist protect the superficial radial sensory nerve 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 EPB is more dorsal than APL has variable anatomy with APL usually having at least 2 tendon slips and its own fibro-osseous compartment a distinct EPB sheath is often encountered dorsally 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
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.253) A 45-year-old patient presents with recurrence of radial sided wrist pain after undergoing a first dorsal compartment release about 3 months ago. The surgery was completed by one of your partners; operative reports indicate that the sheath was incised on the dorsal edge. On physical exam she is found to have normal appearing skin, a negative Tinel’s sign, and a positive Finklestein test. What is the most likely cause of the recurrence of her symptoms? QID: 4613 Type & Select Correct Answer 1 Development of neuroma 1% (79/6075) 2 Complex regional pain syndrome 1% (36/6075) 3 Failure to decompress the EPB sub-sheath 76% (4613/6075) 4 Failure to decompress the EPL sub-sheath 7% (432/6075) 5 Failure to decompress the APB sub-sheath 15% (886/6075) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.9) A 31-year-old mother of a 2-month-old infant complains of radial sided wrist pain. Corticosteroid injections should be directed into what anatomic area? QID: 395 Type & Select Correct Answer 1 First carpometacarpal joint 1% (43/3971) 2 Carpal tunnel 2% (74/3971) 3 First dorsal compartment near the radial styloid 90% (3562/3971) 4 A1 pulley of thumb 1% (33/3971) 5 At the crossing of the first and second dorsal compartments 6% (245/3971) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic
All Videos (4) Podcasts (1) Login to View Community Videos Login to View Community Videos De Quervain's Release Kemal Gokkus Hand - De Quervain's Tenosynovitis C 10/22/2021 387 views 3.0 (1) Login to View Community Videos Login to View Community Videos Dequervain's release Teddy Atik Hand - De Quervain's Tenosynovitis C 7/23/2016 2755 views 4.2 (17) Login to View Community Videos Login to View Community Videos Dequervain's Tendonitis Injection Michael Hughes Hand - De Quervain's Tenosynovitis B 2/22/2013 11232 views 4.4 (35) Hand⎪ De Quervain's Tenosynovitis Hand - De Quervain's Tenosynovitis Listen Now 14:37 min 9/8/2020 547 plays 1.0 (1) See More See Less