Definition
De Quervain tenosynovitis is painful stenosis of the first dorsal extensor compartment, involving abductor pollicis longus and extensor pollicis brevis.
Presentation
- pain over radial styloid
- pain with thumb use or lifting
- focal tenderness and sometimes swelling
It is more common in women and may occur during pregnancy or the postpartum period.
Examination
- tenderness over first dorsal compartment
- pain with resisted thumb extension/abduction
- Finkelstein-type manoeuvre may reproduce symptoms
Differentiate from:
- first CMC osteoarthritis
- scaphoid pathology
- superficial radial nerve irritation
Non-operative treatment
- activity modification
- splinting
- corticosteroid injection into the first dorsal compartment
An intracompartmental septum can reduce injection success if one subcompartment is missed.
Surgery
Persistent symptoms can be treated by surgical release.
Key points:
- protect superficial radial nerve branches
- identify and decompress all APL/EPB subcompartments
- avoid excessive volar release that could permit tendon subluxation
Complications include neuroma, scar sensitivity, incomplete decompression and tendon instability.
Pathology
De Quervain tenosynovitis affects the first dorsal extensor compartment, containing abductor pollicis longus and extensor pollicis brevis.
A septum may divide the compartment, which is clinically important because incomplete release or injection into only one subcompartment can lead to persistent symptoms.
Clinical features
Pain is localised over the radial styloid and is aggravated by thumb movement and ulnar deviation.
Examination includes:
- local tenderness
- pain on resisted thumb abduction/extension
- provocative stretching manoeuvres
Differentiate from:
- first CMC OA
- intersection syndrome
- superficial radial nerve irritation
- scaphoid/radioscaphoid pathology
Treatment
Initial options:
- activity modification
- splintage
- analgesia
- corticosteroid injection
Persistent symptoms may be treated by surgical release.
Operative considerations
Protect branches of the superficial radial nerve. Identify and release all relevant subcompartments while avoiding tendon instability from excessive sheath disruption.
FRCS synthesis
The key anatomical point is first dorsal compartment variation. Persistent symptoms after treatment should prompt consideration of an unrecognised EPB subcompartment or an alternative diagnosis.