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DeQuervain's Tenosynovitis

© Michael McLaughlin

If you have pain that extends from the base of the thumb up into the wrist and forearm and increases with thumb and wrist motion, you may have a treatable condition known as DeQuervain’s tenosynovitis.

DeQuervain’s tenosynovitis was first described in 1895. Although it most commonly occurs in middle aged women, the problem can be seen in men and women of almost all ages. The problem is especially common in people who are doing activities requiring repetitive wrist and thumb motion. It also occurs more often in patients with diabetes, thyroid disease, or people with inflammatory disorders such as rheumatoid arthritis.

The extensor surface (“back”) of the wrist is divided into six compartments by a thin tissue called the retinaculum. The tendons travelling from the forearm to the wrist, thumb, and fingers pass through these various compartments. The first dorsal compartment is the furthest to the radial (thumb) side of the wrist. It contains the tendons of two muscles that move the thumb, the abductor pollicus longus and the extensor pollicus brevus. DeQuervain’s tenosynovitis is the result of inflammation along these tendons within the first dorsal compartment.

Patients with DeQuervain’s tenosynovitis develop pain along the first dorsal compartment that is especially aggravated by movement of the wrist away from the thumb side, and thumb flexion and opposition across the palm. They may also experience a creaking sensation in the area referred to as a “wet leather sign.”

The diagnosis of DeQuervain’s tenosynovitis is made through a typical history and examination. Pain is reproduced on examination by having the patient hold their thumb into their palm while the examiner bends the wrist away from the side of the thumb (a “Finklestein test”). Other disorders in the vicinity of the first dorsal compartment must be distinguished from DeQuervain’s tenosynovitis. Intersection syndrome is a similar condition present in the second dorsal compartment. Basal joint arthritis in the base of the thumb is also very common, and may be present in conjunction with DeQuervain’s. The arthritis will usually be seen on an X-ray of this area.

Treatment of DeQuervain’s is mainly targeted at decreasing the underlying inflammation. This is done by the use of splints and anti-inflammatory medication. Patients are also shown stretching exercises in which they hold the thumb in the palm and angle the wrist away from the thumb side in a way that resembles the Finklestein test. Hand therapy modalities can also be used to decrease the inflammation. Steroid injections can also be very beneficial. If conservative treatment is unsuccessful, then surgical release of the extensor retinaculum overlying the first dorsal compartment may be necessary.