De Quervain syndrome is stenosing tenosynovitis of the short extensor tendon (extensor pollicis brevis) and long abductor tendon (abductor pollicis longus) of the thumb within the first extensor compartment.
(See also Overview and Evaluation of Hand Disorders.)
Historically, De Quervain syndrome was attributed mostly to repetitive use of the wrist, based on observational evidence; however, the cause is likely multifactorial, including hormonal influences, genetic predisposition, anatomic variations, and comorbidities, in addition to repetitive strain (1).
Reference
1. Piligian G, Herbert R, Hearns M, Dropkin J, Landsbergis P, Cherniack M: Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity. Am J Ind Med. 2000;37(1):75-93. PMID: 10573598
Symptoms and Signs of De Quervain Syndrome
The major symptom of De Quervain syndrome is aching pain at the wrist and thumb, aggravated by motion. Tenderness can be elicited just proximal to the radial styloid process over the site of the involved tendon sheaths.
Diagnosis of De Quervain Syndrome
Clinical evaluation, including Finkelstein test
Diagnosis of De Quervain syndrome is highly suggested by the Finkelstein test. The patient adducts the involved thumb into the palm and wraps the fingers over the thumb. The test is positive if gentle passive ulnar deviation of the wrist provokes severe pain at the affected tendon sheaths. A positive hitchhiker's maneuver (pain elicited along first extensor compartment during resisted thumb extension) is also highly suggestive.
Treatment of De Quervain Syndrome
Corticosteroid injection
Thumb spica splint
Sometimes surgery
Rest, warm soaks, and nonsteroidal anti-inflammatory drugs (NSAIDs) may help in very mild cases of De Quervain syndrome.
Local corticosteroid injections and a thumb spica splint help 60 to 80% of cases (1). Tendon rupture is a rare complication of injection and can be prevented by confining infiltration to the tendon sheath and avoiding injection of the corticosteroid into the tendon. Intratendinous location of the needle is likely if injection is met with moderate or severe resistance. Ultrasound guidance is sometimes used.
Surgical release of the first extensor compartment is very effective when conservative therapy fails.
Treatment reference
1. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-DeJong B: Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. BMC Musculoskelet Disord. 2009;10:131. Published 2009 Oct 27. doi:10.1186/1471-2474-10-131
