De quervain tenosynovitis

• 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

• 727.04 Radial styloid tenosynovitis

• M65.4 Radial styloid tenosynovitis [de Quervain]

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

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

Essentials of Diagnosis

• Tenderness with palpation
• Positive resisted isometric test in thumb abduction and extension
• Finkelstein’s test is best for diagnosis

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

Signs and Symptoms

• 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

Functional Implications

• Pain with pinching, grasping, squeezing, holding heavy objects, wringing
• Pain with movements of hand and wrist
• Loss of strength
• Tendon rupture

Possible Contributing Causes

• 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

Differential Diagnosis

• 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

Imaging

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

Diagnostic Procedures

• Resisted isometric testing
• Finkelstein’s test

Medication

• NSAIDs
• Cortisone injection

• 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

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

• Acute stage
  • Rest
  • Cold laser
  • Ultrasound...