From the Guidelines
De Quervain's tenosynovitis is a condition characterized by inflammation of the tendons on the thumb side of the wrist, specifically the abductor pollicis longus and extensor pollicis brevis tendons, which can be effectively diagnosed using ultrasound to identify anatomic variations in the first extensor compartment 1. De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. Some key points about De Quervain's tenosynovitis include:
- The condition occurs when the tendons become inflamed as they pass through a narrow tunnel in the wrist
- Repetitive hand movements, pregnancy, or inflammatory conditions can contribute to the development of De Quervain's tenosynovitis
- Ultrasound can be used to identify anatomic variations in the first extensor compartment, which can help diagnose the condition 1
- Early intervention is crucial in managing De Quervain's tenosynovitis, and seeking treatment when symptoms first appear is recommended The diagnosis and management of De Quervain's tenosynovitis can be guided by the American College of Radiology's appropriateness criteria for chronic wrist pain, which emphasizes the importance of identifying the underlying cause of the condition 1.
From the Research
Definition and Characteristics of De Quervain's Tenosynovitis
- De Quervain's tenosynovitis is characterized by swelling of muscles (abductor pollicis longus (APL) and extensor pollicis (EPB) brevis) at the base of the thumb, leading to a painful and irritating condition 2.
- The disorder is triggered by preexisting tendon degeneration induced by excessive twisting actions and is associated with inflammatory arthritis 2.
- The tendon sheath thickens and becomes constricted if inflammation and swelling persist, and patients who undergo high-torque wrist turning or repetitive everyday movements have a higher risk of developing tenosynovitis 2.
Symptoms and Diagnosis
- De Quervain's tenosynovitis is characterized by pain on the radial (thumb) side of the wrist and functional disability of the hand 3.
- Clinical evaluation is usually required for diagnosis, and imaging studies may be used to confirm the diagnosis or check for alternate diseases 2.
- The Finkelstein test is used to diagnose De Quervain's tenosynovitis, where pain is provoked with wrist ulnar deviation 4.
Treatment Options
- Treatment options include nonsteroidal anti-inflammatory medication (NSAIDs), physical therapy, immobilization with splints, and rest 2.
- Corticosteroid injections or surgery may be considered in situations that do not respond to preventive treatment 2, 3, 5.
- Neural therapy (NT) has also been shown to be effective in reducing pain and improving hand functions in patients with De Quervain tenosynovitis 4.
- Immobilization following injection may not contribute to improved patient outcomes and may increase costs and hinder activities of daily living 6.