Symptoms of De Quervain's Tenosynovitis
De Quervain's tenosynovitis presents with radial-sided wrist pain that is sharp or stabbing, localized to the radial styloid and first dorsal compartment, typically worsening with repetitive thumb or wrist movements. 1
Primary Pain Characteristics
- Pain location: Radial side of the wrist, specifically over the radial styloid and first dorsal compartment 1, 2
- Pain quality: Described as "sharp" or "stabbing" in nature 1
- Pain pattern: Initially present only during activity but may progress to rest pain in chronic cases 1
- Pain triggers: Worsens with repetitive thumb or wrist movements and resisted gliding of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons 1, 3
Physical Examination Findings
- Localized tenderness: Well-localized tenderness directly over the first dorsal compartment at the radial styloid that reproduces the patient's pain 1
- Visible swelling: Swelling over the radial styloid and first dorsal compartment 1, 2
- Positive Finkelstein test: Pain elicited when the thumb is flexed into the palm and the wrist is deviated ulnarly 4, 5
- Absence of joint effusion: Effusions suggest intra-articular pathology rather than tenosynovitis 1
- Erythema and asymmetry: May be present over the affected area 1
Chronic Presentation Features
- Muscle atrophy: Suggests chronicity when present 1
- Functional disability: Progressive impairment of hand function 5
- Persistent symptoms: Pain that continues despite rest and initial conservative measures 1
Special Population: Pregnancy and Postpartum
- Timing: Particularly common in women 4-6 weeks postpartum 6
- Demographics: More prevalent in women aged 30-50 years, especially during or after pregnancy 6, 5
- Presentation: All pregnant or lactating women in one controlled trial experienced complete relief with steroid injection, indicating the condition is highly responsive to treatment in this population 5
Associated History
- Onset pattern: Typically insidious onset that is load-related 1
- Activity correlation: History of new activity or increased intensity of repetitive hand/thumb use is common, though not universally present 1
- Repetitive motion: Results from repetitive loading causing degenerative changes in the APL and EPB tendons 1, 2
Red Flags Suggesting Alternative Diagnosis
- Diffuse wrist swelling: Extending beyond the first dorsal compartment suggests inflammatory arthritis rather than isolated De Quervain's 1, 4
- Multiple tendon involvement: When multiple tendons are symptomatic simultaneously, consider underlying rheumatic disease 1
- Joint effusions or synovitis: Presence of these findings suggests intra-articular pathology 1, 4
- Systemic inflammatory signs: Should prompt evaluation for conditions like rheumatoid arthritis 1