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De Quervain's Tenosynovitis Guide
1. D E Q U E R VA I N ’ S
T E N O S Y N O V I T I S
NURUL WAJIIHAH BINTI MOHAMAD
AZALAN
(1120531)
2. DEFINITION
• Inflammation of the
synovial sheath
• Causing secondary
thickening of the
sheath,
• Stenosis of the
compartment
• Thus compromising
the involved tendon
(APL & EPB).
Apley’s System of Orthopaedics & Fractures 9th
Edition
5. CAUSES
• Caused by unaccustomed overuse (relies on repetitive
hand or wrist movement):
– working in the garden
– playing golf
– lifting baby
• Idiopathic
Apley’s System of Orthopaedics & Fractures 9th
Edition
6. PATHOLOGY
• Reactive thickening of the sheath around
the extensor pollicis brevis and abductor
pollicis longus tendons within the first
extensor compartment
Apley’s System of Orthopaedics & Fractures 9th
Edition
7. CLINICAL FEATURES
• Pain on the radial side of
the wrist
– Tenderness is most acute at
the very tip of the radial
styloid
• Visible swelling over the
radial styloid
• The tendon sheath feels
thick and hard
Apley’s System of Orthopaedics & Fractures 9th
Edition
8. SPECIAL TEST
• 1) Finkelstein’s test.
– Ask the patient to
fully flex the thumb.
– Places the patient’s
thumb across the
palm in full flexion
– Holding the patient’s
hand firmly
– Adduct the wrist joint
(ulnar deviation)
– In a positive test, this
would be painful.
Apley’s System of Orthopaedics & Fractures 9th
9. • 2) Hitch-hiker’s sign (resisted
thumb extension)
– Ask the patient to do:
– Flexion of the MCP joint
– Extension of distal IP joint of
the thumb.
– Patient complains of pain
localized to 1st dorsal
compartment when asked to
extend & abduct the thumb
Apley’s System of Orthopaedics & Fractures 9th
10. TREATMENT
• Early case: corticosteroid injection into the tendon
sheath.
• Hand therapy ( splintage)
• Resistant cases (if pain persists/severe cases) need an
operation (slitting the thickened tendon sheath).
Apley’s System of Orthopaedics & Fractures 9th
12. REFERENCE
• Solomon L, Warwick D, Nayagam S. Apley and Solomon's
System of Orthopaedics and Trauma, Ninth Edition. Hoboken:
CRC Press; 2016.
• http://clinicalgate.com/1-examination-of-the-hand-and-wrist/
Editor's Notes
Particularly in middle aged n sometimes pregnancy
Extensor retinaculum has 6 compartments which transmit tendons lined with synovium. 1st dorsal compartment (APB & EPB) & 2nd dorsal compartment (ECRB) are most commonly affected.
Particularly in middle aged woman (40-50) n sometimes pregnancy
differential
1. Rheumatoid arthritis at the base of the thumb
2. scaphoid non-union
3. Intersection syndrome
Painful because it stretches the tendons of 1st dorsal compartment. Pathognomonic sign
Sometimes there is duplication of tendons and even of the sheathboth sheaths need to be divided
Care should be taken to prevent injury to the branches of radial nerve ,cause intractable dysaesthesia
