What are the physical exam findings for de Quervain's (de Quervain's tenosynovitis) tenosynovitis?

Physical Examination Findings for De Quervain's Tenosynovitis

The most important physical examination finding for de Quervain's tenosynovitis is a positive Finkelstein test, characterized by pain over the radial styloid when the thumb is flexed and the wrist is ulnarly deviated. 1

Key Physical Examination Findings

• Pain and tenderness over the first extensor compartment of the wrist, specifically over the radial styloid process 2
• Positive Finkelstein test - pain elicited when the thumb is flexed into the palm and the wrist is ulnarly deviated 1
• Swelling and thickening over the first dorsal compartment containing the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons 2, 3
• Pain with resisted thumb extension and abduction due to involvement of the APL and EPB tendons 3
• Crepitus may be felt during thumb movement in some cases 4

Anatomical Considerations

• The first dorsal compartment contains two tendons:
  • Abductor pollicis longus (APL) 2
  • Extensor pollicis brevis (EPB) 2
• Anatomical variations can influence presentation:
  • Presence of accessory APL tendons may be associated with de Quervain's tenosynovitis 1
  • Subcompartmentalization within the first dorsal compartment can be detected by ultrasound and may affect surgical management 5

Associated Findings

• Wartenberg's syndrome may coexist with de Quervain's tenosynovitis, presenting as tingling and dysesthesia due to compression of the superficial radial nerve by the swollen first extensor compartment 1
• Limited range of motion of the thumb and wrist due to pain 4
• Difficulty with pinch and grip activities due to pain with thumb movement 3

Diagnostic Techniques

• Ultrasound can be valuable for confirming the diagnosis by showing:
  • Thickened, hypoechoic tenosynovial sheath surrounding the APL and EPB tendons 1
  • Presence of anatomical variations like accessory tendons or septum within the first dorsal compartment 5
• Radiographs are typically normal but helpful to rule out other bony pathologies that may mimic symptoms 3

Clinical Pearls

• The condition is more common in women, particularly between 30-50 years of age 2
• There is increased prevalence in women 4-6 weeks postpartum 2
• Repetitive hand and wrist movements are often associated with symptom development 4
• Differential diagnosis should include:
  • Intersection syndrome (more proximal pain)
  • Osteoarthritis of the first carpometacarpal joint
  • Scaphoid fracture
  • Superficial radial nerve entrapment 3

Remember that early recognition of de Quervain's tenosynovitis through these physical examination findings is crucial for appropriate treatment decisions, as the condition responds well to conservative management, especially in the acute phase 4.