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⇱ De Quervain Tenosynovitis: Practice Essentials, Anatomy, Etiology

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De Quervain Tenosynovitis

Updated: Apr 12, 2024
  • Author: Roy A Meals, MD; Chief Editor: Harris Gellman, MD  more...
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Overview

Practice Essentials

In 1895, a Swiss surgeon, Fritz de Quervain, published five case reports of patients with a tender, thickened first dorsal compartment at the wrist. The condition has subsequently borne his name: de Quervain tenosynovitis. De Quervain tenosynovitis is an entrapment tendinitis of the tendons contained within the first dorsal compartment at the wrist; it causes pain during thumb motion. [1]

Splinting of the thumb and wrist relieves symptoms, but compliance with splinting is a problem. (See Treatment.) Injection of corticosteroid into the sheath of the first dorsal compartment reduces tendon thickening and inflammation. If injection therapy fails, surgical release of the first dorsal compartment relieves the entrapment.

Surgeons have had more than 125 years of experience with de Quervain tenosynovitis. The described treatment options are widely accepted, and no significant controversies exist. No significant changes in diagnosis and treatment are anticipated for this lowly, yet irksome, condition. [2]

For patient education resources, see Tendinitis.

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Anatomy

The tendons of the abductor pollicis longus and the extensor pollicis brevis pass through the first dorsal compartment. The abductor pollicis longus tendon is usually multistranded. The extensor pollicis brevis tendon is typically much smaller than even a single slip of the abductor pollicis longus tendon, and it may be congenitally absent. A septum separating the first dorsal compartment into distinct subcompartments for the abductor pollicis longus tendons and the extensor pollicis brevis tendon is often noted at surgery. [3]

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Etiology

The tendons of the abductor pollicis longus and the extensor pollicis brevis are tightly secured against the radial styloid by the overlying extensor retinaculum. Any thickening of the tendons from acute or repetitive trauma restrains gliding of the tendons through the sheath. Efforts at thumb motion, especially when combined with radial or ulnar deviation of the wrist, cause pain and perpetuate the inflammation and swelling.

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Epidemiology

The most common entrapment tendinitis of the hand and wrist is trigger digit, [4] followed by de Quervain tenosynovitis, though the latter occurs only about one twentieth as often as does trigger digit.

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Prognosis

Relief is permanent following successful surgery. Some patients who have been successfully treated with injections may have recurrent symptoms when they return to lifting infants aged 6-12 months. This author would suggest the following: Relief is usually permanent.

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References

  1. Satteson E, Tannan SC. De Quervain Tenosynovitis. Treasure Island, FL: StatPearls; 2023. [Full Text].

  2. Huisstede BM, Coert JH, Fridén J, Hoogvliet P, European HANDGUIDE Group. Consensus on a multidisciplinary treatment guideline for de Quervain disease: results from the European HANDGUIDE study. Phys Ther. 2014 Aug. 94 (8):1095-110. [QxMD MEDLINE Link].

  3. Kulthanan T, Chareonwat B. Variations in abductor pollicis longus and extensor pollicis brevis tendons in the Quervain syndrome: a surgical and anatomical study. Scand J Plast Reconstr Surg Hand Surg. 2007. 41 (1):36-8. [QxMD MEDLINE Link].

  4. Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, et al. Sonographic appearance of trigger fingers. J Ultrasound Med. 2008 Oct. 27 (10):1407-13. [QxMD MEDLINE Link].

  5. Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J Hand Surg Am. 1994 Jul. 19 (4):595-8. [QxMD MEDLINE Link].

  6. Stephens MB, Beutler AI, O'Connor FG. Musculoskeletal injections: a review of the evidence. Am Fam Physician. 2008 Oct 15. 78 (8):971-6. [QxMD MEDLINE Link].

  7. Diop AN, Ba-Diop S, Sane JC, Tomolet Alfidja A, Sy MH, Boyer L, et al. [Role of US in the management of de Quervain's tenosynovitis: review of 22 cases]. J Radiol. 2008 Sep. 89 (9 Pt 1):1081-4. [QxMD MEDLINE Link].

  8. Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007 Apr. 31 (2):265-8. [QxMD MEDLINE Link].

  9. Orlandi D, Corazza A, Fabbro E, Ferrero G, Sabino G, Serafini G, et al. Ultrasound-guided percutaneous injection to treat de Quervain's disease using three different techniques: a randomized controlled trial. Eur Radiol. 2015 May. 25 (5):1512-9. [QxMD MEDLINE Link].

  10. Pagonis T, Ditsios K, Toli P, Givissis P, Christodoulou A. Improved corticosteroid treatment of recalcitrant de Quervain tenosynovitis with a novel 4-point injection technique. Am J Sports Med. 2011 Feb. 39 (2):398-403. [QxMD MEDLINE Link].

  11. Scheller A, Schuh R, Hönle W, Schuh A. Long-term results of surgical release of de Quervain's stenosing tenosynovitis. Int Orthop. 2009 Oct. 33 (5):1301-3. [QxMD MEDLINE Link].

  12. Jackson WT, Viegas SF, Coon TM, Stimpson KD, Frogameni AD, Simpson JM. Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study. J Bone Joint Surg Am. 1986 Jul. 68 (6):923-6. [QxMD MEDLINE Link].

  13. Dierks U, Hoffmann R, Meek MF. Open versus percutaneous release of the A1-pulley for stenosing tendovaginitis: a prospective randomized trial. Tech Hand Up Extrem Surg. 2008 Sep. 12 (3):183-7. [QxMD MEDLINE Link].

  14. Louis DS. Incomplete release of the first dorsal compartment--a diagnostic test. J Hand Surg Am. 1987 Jan. 12 (1):87-8. [QxMD MEDLINE Link].

  15. Arons MS. de Quervain's release in working women: a report of failures, complications, and associated diagnoses. J Hand Surg Am. 1987 Jul. 12 (4):540-4. [QxMD MEDLINE Link].

  16. McMahon M, Craig SM, Posner MA. Tendon subluxation after de Quervain's release: treatment by brachioradialis tendon flap. J Hand Surg Am. 1991 Jan. 16 (1):30-2. [QxMD MEDLINE Link].

Media Gallery
  • In de Quervain tenosynovitis, the first dorsal compartment is thickened, raising the skin and creating a prominence at the radial styloid.
  • The Finkelstein test draws the tendons of the first dorsal compartment distally and causes sharp, local pain when tendon entrapment has occurred and inflammation is present.
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Contributor Information and Disclosures
Author

Roy A Meals, MD Clinical Professor, Department of Orthopedic Surgery, University of California, Los Angeles, David Geffen School of Medicine

Roy A Meals, MD is a member of the following medical societies: American Society for Surgery of the Hand

Disclosure: Received royalty from George Tiemann Company for other.

Pharmacy Editor

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society, Florida Medical Association, Florida Orthopaedic Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

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