De Quervain's tenosynovitis is inflammation of the tendon sheath of the abductor pollicis longus and extensor pollicis brevis tendons. It is caused by repetitive movements of the wrist and thumb and results in thickening of the tendon sheath and stenosis of the compartment. Patients experience pain on the radial side of the wrist that is worsened by thumb movement. Diagnosis involves tenderness over the radial styloid and a positive Finkelstein's or hitchhiker's sign test. Treatment ranges from corticosteroid injections for mild cases to splinting and possibly surgery to release the tendon sheath for severe or persistent cases.

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

4. Six compartments of extensor
retinaculum

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

11. Thumb spica splint

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/