De Quervain's Tenosynovitis

Question 1

What is De Quervain’s tenosynovitis

Answer 1

> Thickening of tendon sheaths around EPB + APL
- either: idiopathic (spontaneous)
: overuse of thumb (may involve eccentric lowering of wrist into ulnar deviation with load)

Question 2

Risk Factors

Answer 2

> Women (especially new mothers)

> 40’s - 50’s

Question 3

Pathophysiology

Answer 3

> inflammation of tendon sheath of EPB + APL
swelling of sheaths
eventually sheaths begin to thicken and adhesions may form between the tendon and the sheath - restricting normal movement
Tendons can become constricted

Question 4

Clinical Presentation

Answer 4

> Pain on radial side of wrist (refers to thumb)
Aggs: Resisted thumb extension/abduction
: stretching affected tendons (Finkelstein test - grip thumb under fingers of same hand + ulnar deviate)
: palpation of tendons

Question 5

Management

Answer 5

> Physiotherapy
 - Load management
 - Splinting
 - Exercise
 - Education
> NSAIDS
> Corticosteroid injection
> Surgery