De Quervain Tendinopathy

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Background

De Quervain's causes radial-sided wrist pain.

Aetiology

The aetiology is not well understood. There are aetiologic hypotheses, but these are all based on mostly observational data. The condition affects both the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) at the first dorsal compartment, a fibro-osseous tunnel. The APL and EPB allow thumb radial abduction. Histologically the disease is noninflammatory, with thickening of the tendons and the tunnel.

It is most common in the 6-12 month postpartum period in young women. It also commonly affects early childcare workers.

It is usually atraumatic but may result after a direct blow.

Symptoms are often bilateral.

Pain caused by movement of the thumb or wrist.

Diagnosis

Based on characteristic history of atraumatic radial sided wrist pain with tenderness and enlargement of the first dorsal compartment over the radial styloid, and pain at the radial styloid with active or passive stretch of the tendons over the radial styloid in thumb flexion.

Differential Diagnoses

  • Scaphoid fracture (missed)
  • Non-union of scaphoid fracture
  • De Quervain Tendinopathy
  • Scaphoid impaction syndrome
  • Intersection Syndrome
  • Flexor carpi radialis tendinopathy
  • Dorsal pole of lunate impingement on distal radius (gymnasts)
  • Scapholunate dissociation
  • Osteoarthritis of the trapeziometacarpal (TMC) joint
  • Ganglia
  • Radial sensory nerve entrapment in the forearm
  • Crystal-induced arthritis
  • C6 radicular syndrome

Imaging

  • Ultrasound may show a thickened extensor retinaculum with hypervascularity. There may be thickening of the APL and APB tendons, however the EPB may be thinned due to stenosis from a thickened extensor retinaculum.
  • Xray may help evaluate other causes such as OA of the 1st CMC joint.

Management

The condition is normally self-limited. It generally resolves after a year, and doesn't usually recur.

Activity Modification
Splinting

Forearm-based thumb spica splint with the interphalangeal joint free

Steroid Injection

See page on De Quervain Injection

Surgery

There are no placebo-controlled trials. It involves releasing the the first dorsal compartment. Complications included an erythematous, raised, and tender incision area for 6 to 12 months, injury of the superficial radial sensory nerve, failure to improve symptoms, and inability to use the wrist for a few weeks postoperatively.

References

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