De Quervain's Tenosynovitis
Painful tenosynovitis of the first dorsal extensor compartment at the wrist, involving APL and EPB tendons.
Overview
De Quervain's tenosynovitis is a stenosing tenosynovitis of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment of the wrist. Thickening of the extensor retinaculum narrows the fibro-osseous tunnel; a separate compartment for EPB is a common anatomical variant contributing to refractory cases.
Epidemiology
It is most common in women aged 30 to 50, particularly during pregnancy and the postpartum period, and in occupations involving repetitive thumb and wrist use. It is sometimes called 'gamer's thumb' or 'baby wrist'.
Symptoms
Pain and tenderness over the radial styloid, worse with thumb use and ulnar wrist deviation, are characteristic. Finkelstein and Eichhoff tests reproduce symptoms. Palpable thickening of the first dorsal compartment may be felt.
Imaging
Diagnosis is clinical. Ultrasound shows tendon and retinacular thickening, peritendinous fluid, and any subdivided compartments. Plain radiographs exclude thumb CMC arthritis or scaphoid pathology.