From the Guidelines
De Quervain's tenosynovitis is characterized by degenerative changes in the tendon fibers, disorganization of collagen, and infiltration of inflammatory cells, rather than acute inflammation alone, as most patients have chronic symptoms by the time of presentation 1. The pathology of De Quervain's tenosynovitis involves the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons and their synovial sheaths as they pass through the first dorsal compartment of the wrist.
Key Features of the Pathology
- Degenerative changes in the tendon fibers
- Disorganization of collagen
- Infiltration of inflammatory cells
- Thickening and fibrosis of the tendons and surrounding sheaths
- Stenosis of the first dorsal compartment leading to restricted gliding motion of the tendons The condition develops due to repetitive hand and wrist movements that create friction and irritation, leading to chronic symptoms such as pain, swelling, and limited thumb movement 1.
Histological Classification
One classification scheme for tendinopathies includes:
- Acute tendonitis alone
- Chronic tendinosus with acute tendonitis
- Chronic tendinosus alone 1 However, most patients with De Quervain's tenosynovitis have chronic symptoms, suggesting a degenerative condition rather than an acute inflammatory process 1.
Diagnostic Considerations
Imaging studies such as plain radiography, ultrasonography, and magnetic resonance imaging can be helpful in diagnosing De Quervain's tenosynovitis, but are not always necessary 1.
Treatment Implications
Understanding the degenerative nature of De Quervain's tenosynovitis is important for guiding treatment, which may include relative rest, icing, eccentric strengthening exercises, and other modalities to promote tendon healing and reduce pain 1.
From the Research
Pathology of De Quervain's Tenosynovitis
The pathology of De Quervain's tenosynovitis is characterized by:
- Non-inflammatory thickening of the tendinous sheath, leading to entrapment of the individual tendons and increased friction 2
- Inflammation of the tendon sheath of the musculus abductor pollicis longus (APL) and the musculus extensor pollicis brevis (EPB) in the first extensor compartment of the wrist 3
- Pain results from resisted gliding of the abductor pollicis longus and the extensor pollicis brevis tendons in the fibro-osseus canal 4
Clinical Presentation
De Quervain's tenosynovitis typically presents with:
- Pain on the radial side of the wrist, particularly with repetitive wrist ulnar deviation with thumb abduction and extension 5
- Functional disability of the hand 6
- Tenderness over the first extensor compartment of the wrist 2
- Positive Finkelstein test 5
Etiology
The etiology of De Quervain's tenosynovitis is often unknown, but it can be associated with: