EMed

De Quervain's Tenosynovitis

Aetiology

  • Painful inflammation of EPL and APB tendons of the thumb in tendon sheath
  • Overuse, repetitive pinching or grasping cause inflammation
  • Histolgy: myxoid degeneration & chronic inflammation, with scar formation and stenosis of the approximately 1cm section of the fibro-osseous tunnel
  • 1895 Fritz de Quervain (Swiss)

Symptoms

  • Pain in distal radial forearm may radiate to thumb or proximally
  • F:M = 8:1
  • Check for crepitus over tendon sheaths
  • Finklestein's test positive
  • Classically in mothers of infants or manual labourers
  • Finklestein's test helps differentiate from intersection syndrome

Treatment

  • Treat acute episode with thumb immobilisation and NSAIDs
  • May require PoP for 1/12
  • No evidence to support steroid injections in acute cases [BestBets]
  • Check rheumatoid autoantibody screen in persistent cases
  • More chronic cases warrant a trial steroid injection
  • Surgical release of tendon sheath occasionally required
finkelsteins1
Finkelstein's
T2-weighted MRI image sequence showed abnormal segmental tendinous thickening involving the first dorsal extensor component of the wrist just proximal the radial styloid process, with a mild amount of fluid within the tendon sheath.
MRI - enflamed tendon

Content by Dr Íomhar O' Sullivan. Last reviewed Dr ÍOS 7/02/23.