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Condition/Disorder Synonyms

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  • Washer woman's sprain

  • Radial styloid tenosynovitis

  • DeQuervain's tenosynovitis

  • De Quervain disease

  • De Quervain's tenosynovitis

  • De Quervain's stenosing tenosynovitis

  • Mother's wrist

  • Mommy thumb

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ICD-9-CM Code

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  • 727.04 Radial styloid tenosynovitis

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ICD-10-CM Code

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  • M65.4 Radial styloid tenosynovitis [de Quervain]

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Preferred Practice Pattern

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Key Features

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Description

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  • Inflammation and thickening of the abductor pollicis longus and extensor pollicis brevis synovial tendon sheaths and extensor retinaculum2

  • Named after Swiss surgeon, Fritz de Quervain

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Essentials of Diagnosis

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  • Tenderness with palpation

  • Positive resisted isometric test in thumb abduction and extension

  • Finkelstein's test is best for diagnosis

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General Considerations

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  • Entrapment tendonitis, tendon friction

  • Often a direct result of repetitive stress or chronic overuse of extensor and abductor muscles causing excessive friction to tendon sheath

  • Patients likely to develop adhesions and irritation between tendons and their sheaths

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Demographics

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  • Mostly found in women aged 30 to 50 years, possibly due to great angle of the styloid process

  • Common among individuals who perform any activity requiring repetitive hand and wrist movement

  • At-risk populations include

    • Massage therapists

    • Musicians

    • Milliners

    • Gardeners

    • Office workers

    • Pregnant and postpartum women

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Clinical Findings

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Signs and Symptoms

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  • Forearm pain

  • Crepitus of tendons within the extensor sheath

  • Unilateral palmer pain and swelling

  • Tendon friction rub

  • Upper-extremity pain

  • Weak thumb abduction

  • Decreased grip strength

  • Wrist pain and swelling

  • Decreased abduction ROM of the carpometacarpal (CMC) joint, thumb

  • Pain with thumb activity, worsens when combined with wrist radial or ulnar deviation

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Functional Implications

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  • Pain with pinching, grasping, squeezing, holding heavy objects, wringing

  • Pain with movements of hand and wrist

  • Loss of strength

  • Tendon rupture

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Possible Contributing Causes

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  • Occupations that require repetitive use of hands for excessive periods of time

  • A direct trauma to the tendon or wrist

  • Inflammatory arthritis, such as rheumatoid arthritis

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Differential Diagnosis

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  • Rheumatoid arthritis

  • Carpal tunnel

  • Osteoarthritis

  • Intersection syndrome: pain 2 to 3 inches proximal to wrist

  • Infection

  • Dorsal wrist ganglion (tumor)

  • Trigger finger

  • Scaphoid fracture (history of trauma, tenderness over snuffbox)

  • Wartenberg's syndrome: radial nerve entrapment at the forearm

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray to rule out arthritis at thumb CMC joint

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Diagnostic Procedures

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  • Resisted isometric testing

  • Finkelstein's test

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Treatment

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Medication

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  • NSAIDs

  • Cortisone injection

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Referrals/Admittance

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  • To primary or secondary healthcare ...

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