4.3. Orthopaedic Problems of the Hand - De Quervain's Tenovaginitis

Question 1

What are the Symptoms of De Quervain’s Tendovaginitis?

Answer 1

1. Several weeks of pain, localised to the radial side of the wrist
2. Pain is aggrevated by Thumb movement
3. May have localised swelling
4. Localised tenderness over the Tunnel

Question 2

Which sex is most likely to get De Quervain’s Tendovaginitis?

Answer 2

Females (6:1)

Question 3

What is the most common age of presentation of De Quervain’s Tendovaginitis?

Answer 3

50s to 60s

Question 4

What is De Quervain’s Tendovaginitis associated with?

Answer 4

1. Post-Partum Females
2. Lactating Females
3. Activities with frequent Thumb Abduction
4. Activities with frequent Ulnar Deviation
   “Washerwoman’s Sprain”

Question 5

What is the Clinical Pathology of De Quervain’s Tendovaginitis?

Answer 5

At the 1st Dorsal Extensor Compartment:

1. There becomes a Fibro-Osseous Tunnel at the Distal Radius
2. Thickening of the Localised Segment
3. 30% of the compartment is divided by a Septum

Question 6

What is considered as a differential for De Quervain’s Tendovaginitis?

Answer 6

Base of the Thumb Osteoarthritis

Question 7

What is the initial investigation of De Quervain’s Tendovaginitis?

Answer 7

Examination of the Thumb Joint:

1. Finklestein’s Test
2. Resisted Thumb Extension

Question 8

How is Finklestein’s Test performed?

Answer 8

1. Hold the patient’s Thumb underneath their fingers (in a wrist formation)
2. Extend the Ulnar Nerve, by pushing the base of the Thumb away from the body
3. In a positive test, there will be pain in the wrist - distal to the base of the Thumb

Question 9

What is the Non-Operative management of De Quervain’s Tendovaginitis?

Answer 9

1. Splints

2. Steroid Injection

Question 10

What is the Operative management of De Quervain’s Tendovaginitis?

Answer 10

1. Decompression