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What is a DeQuervain's?
DeQuervain's is inflammation of the tendons on the side of your wrist (near your thumb).
Our hand tendons attach muscle to the finger bones, and this allows the fingers to move. Our tendons need to glide smoothly and so there is a sheath that surrounds each tendon, and it bathes the tendon in fluid so gliding occurs with minimal friction (just like there is fluid within the knee joint to prevent friction).
In DeQuervain's, inflammation occurs within the tendon sheath, and this prevents smooth gliding. The increased friction is incredibly painful.
The tendon sheath in DeQuervain's is called the "1st Extensor Compartment" of the wrist (there are 6 total) and it contains two tendons, the abductor pollicus longs (APL) and the extensor pollicus brevis (EPB), both tendons attach to the thumb bones.
There are many causes for this condition, but its generally associated with overuse (especially in golfers and racquet sports), but can also occur after an injury to the wrist.
How is a DeQuervain's diagnosed?
The diagnosis of DeQuervain's is made by examining the hand and wrist. X-rays are typically not needed to make the diagnosis (because x-rays are great at showing our bones, but doctors cannot see inflammed tendons on an x-ray).
There is a specific test, the Finklestein's test, which is remembered by anyone that sees their doctor for this condition because its painful! The test reproduces the pain in the wrist because it stretches the inflamed tendons. A painful Finklestein's test = DeQuervain's tenosynovitis.
How is a DeQuervain's treated?
There is good and bad news. The good news is that treatment is usually non-surgical, but the bad news is that a needle is involed.
Rest and a protective splint, in combination with icing and anti-inflammatories can sometimes successfully treat the condition. However, because the pain is caused by repetitive activities, if you remove the splint and start doing those activities again, there is high likelihood the pain will return.
Steroid injections however are helpful 80% of the time (the injection is done with the aid of ultrasound machine to localizing the inflamed tendon).
If the steroid injection fails (usually doctors are willing to try an injection two times before saying that it doesnt help) then surgery is sometimes required if the pain is severe and it prevents normal daily activities. Its been found that the injection usually fails only when there is an atypical anatomy of the wrist tendons which prevents the steroids from flowing to the area of inflammation. Surgery is very effective in treating these cases.
What is the long term outcome?
People with this condition do well after being treated. The expectation is for the inflammation to improve and not return.
1. Ilyas AM et al. de Quervain tenosynovitis of the wrist. JAAOS 2007; 15: 757-64. see article. review.
2. de Quervain F. On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds: 1895. Am J Orthop 1997;26:641-644. see article. historical interest: original description of condition.
3. Ranney D et al. Upper limb musculoskeletal disorders in highly repetitive industries: Precise anatomical physical findings. Ergonomics 1995;38:1408-1423. see article. most common in women (6x) with repetitive, lifting/cleaning type jobs.
4. Schumacher HR Jr et al. Occurrence of De Quervain’s tendinitis during pregnancy. Arch Intern Med 1985;145:2083-2084. see article. there is a self-limiting variant commonly seen in pregnant women.
5. Finkelstein H: Stenosing tendovaginitis at the radial styloid process. JBJS 1930;12:509-540. see article. classic diagnostic test.
6. Harvey FJ, Harvey PM, Horsley MW: De Quervain’s disease: Surgical or nonsurgical treatment. J Hand Surg 1990;15:83-87. see article. 60 patients, 80% improvement with 1 or 2 steroid injections. those that failed to improve went to surgery, all had EPB in separate compartment.
7. Richie CA III, Briner WW Jr: Corticosteroid injection for treatment of de Quervain’s tenosynovitis: A pooled quantitative literature evaluation. J Am Board Fam Pract 2003;16:102-106. see article. looked at other treatments. NSAIDS alone 0% effective in long-term rx, splint only 15% effective. steroids is the way to go.
8. Ta KT, Eidelman D, Thomson JG: Patient satisfaction and outcomes of surgery for de Quervain’s tenosynovitis. J Hand Surg 1999;24:1071-1077. see article. treatment of refractory pain is 91% successful with surgery. anatomic variant is the rule, rather than exception when preparing surgically.