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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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  • 727.04 Radial styloid tenosynovitis

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  • M65.4 Radial styloid tenosynovitis [de Quervain]

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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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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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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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Medication

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  • To primary or secondary healthcare provider for corticosteroid injection to sheath
  • To orthopedist for wrist/thumb splint allowing movement at the thumb interphalengeal (IP) joint only

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  • Hand weakness with grasping, squeezing, pinching
  • Restricted ROM in thumb abduction and extension

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