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De Quervains Tenosynovitis- Quick review card

DE QUEARVAINS TENOSYNOVITIS ( DQD )

 

first described in 1895 by Fritz de Quervain as stenosing fibrous tendovaginitis extensor tendons are divided into 6 compartments ( each has its own sheath ) as they cross the dorsum of the wrist a stenosing condition at the first dorsal compartment – affects the
○ extensor pollicis brevis tendon
○ abductor pollicis longus tendon non inflammatory thickening of tendons and the sheath ( tendon entrapment ) of the 1st dorsal extensor sheath and the the tendon cannot run smoothly inside the tendon sheath ( where the tendon passes through the fibro-osseous tunnel located along the radial styloid at the distal wrist ) aetiology is not clear and histopathological investigations indicate that it is more likely due to intrinsic degenerative mechanism rather than due to inflammation also known by other names as de Quervain’ disease , de Quervain’s syndrome , de Quervain’s tendinopathy , stenosing tenosynovitis of the 1st doral compartment of the wrist , gamer’s thumb and mother’s thumb.

 

 

DQD is a common condition seen in middle ages 2nd most common entrapment tendinopathy after trigger finger more common in women ( perimenopausal , pregnant , lactating ) , no racial predilection often quoted that it is more common in drummers , athletes , manual workers , racket sports players , volley ball players , pianists , carpentry , video games , knitting studies have shown that neither heavy manual labor nor trauma to be associated with DQD cases can be attributed to overuse and local trauma can precipitate the condition.

 

diagnosis is clinical pain with grasp , twisting and pulling movements trouble with daily activities as opening a jar pain located in the area of radial styloid pain may radiate proximally to the forearm and / or distally to the thumb tenderness over radial styloid is usually present ,swelling may be noted ( 1-2 cm proximal to the radial styloid along the course of the EPB & APL tendons ) tests as Finkelstein ( provocative test – see video on YouTube ) , Eichhhoff , Brunelli- aid in diagnosis.

 

ultra sound is a fast and efficient way of confirming diagnosis ( shows thickening of the extensor retinaculum & tendons of the APL , EPB , particularly the EPB tendon ) XR may help ( not diagnostic ) in differentiating other causes as thumb carpometacarpal joint OA , fracture MRI – sensitive and specific in detecting mild disease particularly when US is equivocal

 

intersection syndrome OA of the 1st CMC jt scaphoid OA trigger thumb superficial radial nerve neuritis fracture of the scaphoid or distal radius.

 

some cases may resolve themselves avoiding repetitive or aggravating cause ( activity modification / ergonomics ) , analgesia ( NSAIDs ) , ice/ heat packs soft tissue massage graded pain-free active exercises splinting ( off load the tendons by immobilizing the wrist and thumb ) , patients may find this restrictive ( compliance )
○ splints come in different types e,g rigid thermoplastic or made of semi-stiff fabric
○ 4-6 weeks of full time splinting may be needed corticosteroid injection – 1 or 2 injections can provide near complete relief ( into the sheath of the 1st dorsal compartment ) clinically steroid inj’s are the most common modality to Rx DQD complications of steroid inj include skin thinning due to fat necrosis of s/c tissue , skin depigmentation , tendon rupture.

 

for cases which fail to resolve with conservative methods various techniques available – decompression of the 1st dorsal compartment and in some cases reconstruction to prevent possible subluxation of tendons.

PATIENT INFORMATION

British Society of Surgery of Hand https://www.bssh.ac.uk/patients/conditions/19/de_quervains_syndrome

Family Doctor Org https://familydoctor.org/condition/de-quervains-tenosynovitis/

A concise information section from The American Academy of Orthopaedic Surgeons https://orthoinfo.aaos.org/en/diseases–conditions/de-quervains-tendinosis/

Sussex MSK Partnership – exercises , printable for DQD https://www.sussexmskpartnershipcentral.co.uk/wp-content/uploads/2020/07/Exercises-for-De-Quervains-V2.pdf

Oxford Radcliffe Hospital NHS Trust – exercises , printable https://www.thecharlburymedicalcentre.nhs.uk/website/K84610/files/110811dequervains.pdf

Lecistershire Partnership https://www.leicspart.nhs.uk/wp-content/uploads/2021/08/595-De-Quervains.pdf

REFERENCES

  1. Satteson E, Tannan SC. De Quervain Tenosynovitis. [Updated 2021 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442005/
  2. Division of Plastic & Reconstructive Surgery, Hand & Microsurgery, American University of Beirut Medical Center, Lebanon The De-Quervain Tensosynovitis : Literature Review Bachar Chaya, Elsa Bakhach and Joseph Bakhach* Received: August 27, 2018;   Published: September 05, 2018; *Corresponding author: Bakhach J, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut 1107-2020, Lebanonhttps://biomedres.us/fulltexts/BJSTR.MS.ID.001691.php
  3. The side of my wrist hurts : De Quervains tenosynovitis by Victoria Allbrook AJGP Volume 48 , Issue 11 , November 2019 RACGP – The side of my wrist hurts
  4. De Quevains’s Disease Interesting Case Series Kushal R. Patel, BA, Kashyap K. Tadisina, BS, and Mark H. Gonzalez, MD, MEng
    Department of Orthopedic Surgery, University of Illinois College of Medicine, Chicago
  5. De Quervain’s Tenosynovitis De Quervain’s Tenosynovitis – Hand – Orthobullets
  6. Mak, Jenson. “De Quervain’s Tenosynovitis: Effective Diagnosis and Evidence-Based Treatment”. Work-related Musculoskeletal Disorders, edited by Orhan Korhan, IntechOpen, 2018. 10.5772/intechopen.82029.

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