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De Quervain's tenosynovitis
What's new
Added 2024 AAFP, 2024 ACR, and 2014 HANDGUIDE guidelines for the diagnosis and management of de Quervain's tenosynovitis .
Background
Overview
Definition
De Quervain's tenosynovitis is a tendon entrapment condition involving the abductor pollicis longus and extensor pollicis brevis tendons, which become restricted within the first dorsal compartment.
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Pathophysiology
The etiology and pathogenesis of de Quervain's tenosynovitis are unknown, though repetietive movements and overuse have been proposed as contributing factors. Non-inflammatory thickening of the tendons and swelling of the tendon sheaths leads to impaired gliding of the tendins through the first dorsal compartment.
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Epidemiology
The incidence of de Quervain's tenosynovitis is estimated at 2.8 per 1,000 person-years in women and 0.6 per 1,000 person-years in men among military personnel in the US. The prevalence in the general population in the United Kingdom is estimated at 1.3% in women and 0.5% in men.
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Risk factors
Risk factors for de Quervain's tenosynovitis include overuse, repetitive movements, certain activities and occupations involving strenuous wrist use, such as hammering, as well as pregnancy and the postpartum period (lifting and holding an infant).
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Disease course
Most patients with de Quervain's tenosynovitis present with persistent wrist pain and swelling over the first extensor dorsal compartment, which may radiate to the thumb and forearm. The pain is typically worsened by thumb or wrist movement, particularly during thumb abduction, extension, or ulnar and radial deviation, and is relieved with rest.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of de Quervain's tenosynovitis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2023), the American College of Radiology (ACR 2024), and the European HANDGUIDE Study Group (HANDGUIDE 2014).
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Diagnostic investigations
Physical examination: as per AAFP 2024 guidelines, perform a physical examination to identify tenderness and swelling in the first dorsal compartment and a positive Finkelstein test, indicating de Quervain's tenosynovitis, while dorsal predominance of pain and a squeaking sound during wrist movement indicate intersection syndrome.
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Diagnostic imaging
Medical management
Nonpharmacologic interventions
Splinting: as per HANDGUIDE 2014 guidelines, consider offering splinting (long lower arm-based splint incorporating the wrist) for 3-8 weeks to decrease the amount of mechanical friction of the painful tendons (abductor pollicis longus and extensor pollicis brevis) in order to reduce the symptoms of de Quervain's tenosynovitis.
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Therapeutic procedures
Surgical interventions
Indications for surgery
As per HANDGUIDE 2014 guidelines:
Consider offering surgery to reduce the mechanical friction between the roof of the first compartment and the abductor pollicis longus and the extensor pollicis brevis by surgically opening the compartment. in order to reduce the symptoms of de Quervain's tenosynovitis.
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Perform surgery preferably under local anaesthesia with either a transverse or longitudinal incision.
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Patient education
Counseling on hand movements: as per HANDGUIDE 2014 guidelines, advise patients to avoid activities causing mechanical friction of the affected tendons in order to decrease the pain and swelling. Advise avoiding repetitive thumb and wrist movements, static exercises, thumb flexion, ulnar deviation, and forceful manual movements as much as possible.
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Follow-up and surveillance
Postoperative care: as per HANDGUIDE 2014 guidelines, advise patients on the following for the first 10-14 days postoperatively:
elevate the hand above heart level to prevent swelling
move the fingers to prevent scar adhesions
refrain from heavy lifting or forceful activities until 2-6 weeks after surgery
rest the hand and avoid thumb activity (splinting can be used).
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