DE QUERVAIN'S SYNDROME …ANATOMY , ETIOLOGY , CLINICAL FEATURES ,DIAGNOSIS , EXAMINATION AND MANAGEMENT

2. CONTENTS :
 Definition
 Anatomy
 Aetiology
 Incidence
 Clinical features
 Diagnosis
 Examination
 Management

3. Definition :
De Quervain disease is a chronic
constrictive tenosynovitis
affecting the Abductor Pollicis
Longus and Extensor Pollicis
Brevis tendon of the thumb at
the wrist.
These muscles are located on
the dorsal side of forearm and
go to the lateral side of the
thumb through a fibrous
osseous tunnel .

4. ANATOMY :
• The dorsal aspect of wrist contains six compartment that transmit
the tendon to the hand.
• The first dorsal compartment is located over the radial styloid
proximal to the radio- carpal joint .
Muscles are :
1) Extensor Pollicis Brevis (EPB)
2) Abductor Pollicis Longus (APB)

5. Extensor Pollicis Brevis ( EPB)
• Origin - ½ dorsal side of radius
• Insertion - base of proximal
phalanx of thumb
• Action – radial abduction, thumb
extension
• Nerve supply – radial nerve
Abductor Pollicis Longus (APL)
• Origin – dorsal side of radius and
ulna
• Insertion – base of metacarpal
• Action – extension of thumb
• Nerve supply – radial nerve

6. Aetiology :
• De Quervain is named after the Swiss surgeon FRITZ DE QUERVAIN
Who first described it .
• It describes the inflammation of the sheath or tunnel that surround
two tendons that control the movement of the thumb .
• Main cause is repetitive use of the thumb in combination with radial
deviation of the wrist.
• Characterized by degeneration and fibrosis of the tendon sheath .

7. Tendon of abductor pollicis longus and extensor pollicis brevis are tightly secured
against the radial styloid by the overlying retinaculum
Acute or repetitive trauma restrains gliding of the tendon result in inflammation of
synovial sheath
Increases friction
Reactive fibrosis and thickening of the sheath
Degeneration

8. INCIDENCE :
• Occurs most often in individuals age between 30 and 50 yrs
• It affects women up to six times more often than men
• It commonly associated with dominant hand

9. Clinical features :
- Complain with pain on radial side of
wrist that is worsened by moving the
wrist or thumb.
- Tendon sheath may feel thick and
hard
- Swelling in anatomical snuff box
- Acute Tenderness at tip of radial
styloid
- Pain aggrevates on grasping object
- Wet leather sign
- Finkelstein test is positive
FINKELSTEIN TEST :-
it is provocative test used in
diagnosis for de quervain synovitis
- Make a fist with the thumb
inside
- Now ask patient to bend the
wrist toward the little finger

10. Diagnosis :
1. CMC arthritis of thumb :
pain and crepitus present
with the thumb “crank
and grind test”
2. Chauffeurs fracture
3. Intercarpal instabilities
4. Scaphoid fracture
5. Wartenberg’s syndrome :
nerve become compressed
btw tendon of
Brachioradialis and extensor
carpi Radialis Brevis .
6. C6 Cervical Radiopathy
7. Osteoarthritis of 1st CMC
8. Intersection syndrome

11. EXAMINATION :
1.] ON OBSERVATION :
- Resting posture of hand /thumb
- Inflammation around dorsal part of base of thumb
2.] ON PALPATION :
- Tenderness over the base of thumb and 1st dorsal compartment extensor
tendon
- Thickening of synovial sheath
3.] RANGE OF MOTION :
-Cervical ROM
- Shoulder ,elbow ,forearm ,wrist ROM

12. 4.] FIST GRIP STRENGTH
5.] PINCH STRENGTH
6.] NEUROLOGICAL TEST :
- Superficial radial nerve
- Tinnels sign
7.] NEUROLOGICAL INVOLVEMENT :
- dermatome ( C4 - T1 )
- myotome (C4 – T1 )
- reflexes ( C5 C6 C7 )

13. MANAGEMENT :
 GOALS OF TREATMENT :-
- Restoration of Normal, painless use of involved hand
- Resolution of inflammatory process
- Prevention of recurrence
- Restoration of pain free movement and strength

14. Medical management :
1.) Corticosteroid injection :
-can be given to patient with moderate to marked pain with
symptoms lasting for more than 3 weeks
2.) NSAIDS :
- It is prescribed initially for 6- 8 weeks to reduce pain and
inflammation

15. Physiotherapy management :
1. Immobilization :-
-thumb splint is used to restrict
thumb movement so that first dorsal
compartment tendon are at rest
2. Cold compression :-
-10-12 min over inflamed area
3. Ultrasonic therapy :-
- Pulsed mode ,3MHZ ,time 5 min
4. Phonopheresis :
-with 10% hydrocortisone
5. Gentle active and passive motion
of thumb and wrist
6. Strengthening and stretching
exercise
7. Rehabilitation exercise :
- Wrist stretch
- Wrist flexion extension
- Grip strengthening
- Finger spring

16. Surgery management :
Decompression surgery :-
 after 0-2 days of surgery
Immobilization with cast
After 48 hours dressing are
removed
2-14 days
Presurgical splint is worn for
comfort and active exercise
2-6 weeks
Grip and pinch strengthening
exercise may begin at approx. 3
weeks and can be progressed ,by
the end of 6 week the patient
usually able to resume full
activities .