De Quervain Tenosynovitis: Overview

De Quervain Tenosynovitis: Overview

This video will provide an overview of De Quervain tenosynovitis, a painful condition that impacts the tendons that move the thumb. The condition is named after Fritz de Quervain, a Swiss surgeon who first classified it in the late 1800s. Tenosynovitis means inflammation of a tendon sheath called the synovium. This sheath is a protective layer. The thumb can move in many directions and has multiple tendons. Tendons attach muscles to bones and allow for movement. In this condition, 2 tendons are impacted: the abductor pollicis longus or A P L, and the extensor pollicis brevis or E P B.

The APL and EPB allow the thumb to extend. These 2 tendons run through a small tunnel in the wrist called the first extensor compartment. The sheaths of these tendons are what become inflamed and thickened in this condition, leading to constriction in the tunnel. The causes of this condition are multifactorial and a pinpoint cause remains in debate. Genetics, repetitive movements, variations in the normal tendon anatomy, and inflammatory and hormonal chemical changes in the body may contribute to the condition.

De Quervain tenosynovitis most commonly affects adults, primarily women between the ages of 30 and 50. Women are impacted by the condition 6 times more frequently than men. Postpartum women who repetitively use these tendons to lift their babies and are having hormonal and inflammatory changes in the body are at particular risk of the condition. Additional risk occurs in those who perform repetitive motions, such as grasping or twisting with their hands and wrists, such as assembly line workers or athletes who play racket sports.

Lastly, those with certain medical conditions, such as rheumatoid arthritis or diabetes, may also be at increased risk of this condition. Those with De Quervain tenosynovitis report pain and tenderness over the thumb side of the wrist. This pain may be worse when the thumb is extended, the same position as giving a thumbs-up. The diagnosis is clinical, meaning it is often based on symptoms and examination, and no imaging is needed. A health care provider will check to see if the patient has pain when the thumb is tucked into the palm and pulled downward.

While imaging tests are not routinely ordered to make a diagnosis, an ultrasound or MRI may be considered if the diagnosis is uncertain. In summary, De Quervain tenosynovitis is characterized by inflammation of the protective coverings of the tendons that extend the thumb. Its causes are multifactorial and the condition is more common in women. Pain is present on the thumb side of the wrist. The diagnosis is most often made with the exam and history alone.