De Quervain's Tenosynovitis

Question 1

What is De Quervain’s tenosynovitis

Answer 1

Inflammation of the tendons within the first extensor compartment of the wrester resulting in wrist pain and swelling

Question 2

Risk factors

Answer 2

Female
30-50
Pregnancy
Occupation or hobbies involving repetitive movement of the wrist

Question 3

Describe the extensor compartments of the wrist

Answer 3

6 extensor compartments on the dorsal aspect of the wrist, each containing separate tendon groups.
(lateral to medial)
1. extensor pollicis braves and abductor pollicis longs
2. extensor carpi radialis longus and brevis
3. extensor pollicis longue
4. extensor indices and extensor digitorum
5 extensor digiti minimi
6 extensor carpi ulnaris

Question 4

What tendons are involved in De Quervain’s tenosynovitis?

Answer 4

extensor pollicis braves and abductor pollicis longus

Question 5

What are the clinical features of De Quervain’s tenosynovitis?

Answer 5

Pain near the base of the thumb with an associated swelling (secondary to thickening of the tendon sheath)
Movements involving grasping or pinching are particularly painful and difficult.

Question 6

hat is Finkelstein’s test?

Answer 6

Patient makes a fist over their thumb, placing the thumb inside a closed fist and ulnar deviates their wrist.
Pain is felt in the raidal styloid region in positive Finkelstein’s.
Compare sides

Question 7

What are DDX for De Quervain’s tenosynovitis?

Answer 7

Arthritis of the carpocetacarpal joint - more gradual in onset, usually with a negative Finkelstein’s test and positive Grind test (forcefully pushing thumb against CMC joint whilst rotating it slightly producing pain felt on volar side of wrist.

Intersection syndrome - tendons of first compartment cross over with those of the second compartment resulting in pain over the second compartment

Wartenberg’s syndrome - neuritis of the superficial radial nerve

Question 8

Ix in De Quervain’s

Answer 8

Diagnosis is clinical

plain radiograph to exclude arthritis/fracture

Question 9

What is the management for DQT

Answer 9

Conservative management - lifestyle advice (avoiding repetitive action), wrist splint with thumb to immobilise, analgesia

Medical - steroid injections to reduce swelling and relieve pain

Surgical - decompression of the extensor compartment under local or general anaesthetic
Involves a transverse or longitudinal incision made and the tendon sheath split in the central aspect in a longitudinal direction, thus allowing the tunnel roof to form again as it heals but wider and with more space

Question 10

What are complications of surgical management?

Answer 10

Failure to resolve
Reduced range of movement
Neuroma formation
nerve impoingmenet