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172: DE QUERVAIN TENOSYNOVITIS

Abby Lopez, LMT, CT, NCTMB; Eric Shamus, PhD, DPT, PT, CSCS; Mae L. Yahara, MS, PT, ATC

CONDITION/DISORDER SYNONYMS

  • Washerwoman’s sprain

  • Radial styloid tenosynovitis

  • de Quervain tenosynovitis

  • de Quervain disease

  • de Quervain stenosing tenosynovitis

  • Mother’s wrist

  • Mommy thumb

ICD-9-CM CODE

  • 727.04 Radial styloid tenosynovitis

ICD-10-CM CODE

  • M65.4 Radial styloid tenosynovitis [de Quervain]

PREFERRED PRACTICE PATTERN

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1

PATIENT PRESENTATION

The patient is a 48-year-old woman who started a new job 6 months ago as a bookkeeper. She has been experiencing pain in the right wrist for approximately 1 month. The pain and tenderness are in the region of the styloid process of the radius. She states that the pain radiates into the forearm and thumb as her day progresses. She states that the pain began as a dull ache at the end of the day, but has progressed to the point of inability to complete her morning activities because of the discomfort. Her daily routine includes counting bills and receipts in the morning using her right hand with a repetitive pronation to supination movement. In the afternoon, her work is primarily done utilizing a keyboard. She has no hobbies, but does routine housework and cooking for herself and her spouse.

KEY FEATURES

Description

  • 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

  • Chronic tendinosis

FIGURE 172-1

Finkelstein test. The patient places the thumb in the palm and makes a loose fist. The examiner then ulnarly deviates the patient’s wrist (as indicated by the arrow). Pain at the first dorsal compartment with this maneuver is a positive response. (From Brunicardi FC, Andersen D, Billiar T, et al., eds. Schwartz’s Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Essentials of Diagnosis

  • Tenderness with palpation

  • Positive resisted isometric test in thumb abduction and extension

  • Finkelstein test is best for diagnosis3

General Considerations

  • 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

Demographics

  • 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

CLINICAL FINDINGS

...

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