De Quervain tendinopathy
De Quervain tendinopathy is noninflammatory thickening of the abductor pollicis longus and extensor pollicis brevis tendons at the first dorsal wrist compartment, diagnosed clinically by radial wrist pain reproduced on the Finkelstein test. First-line care is rest, NSAIDs, and thumb spica splinting, escalating to corticosteroid injection and then surgical release for refractory cases.
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What this article covers
- Overview
What it is: de Quervain tendinopathy (de Quervain stenosing tenosynovitis) is noninflammatory thickening of the tendons that cross the first dorsal compartment of the wrist at the base of the thumb.
- Epidemiology
Classic demographic: new parents holding an infant with an outstretched thumb are a recognized group, as are people with frequent handheld-device use.
- Risk factors
Repetitive thumb and wrist use: repetitive gripping, pinching, or ulnar-deviated wrist motion, as in an infant-carrying posture or frequent handheld-device use, is the dominant mechanical trigger.
- Pathophysiology
Mechanical overload of the first dorsal compartment: repetitive gripping or ulnar deviation loads the abductor pollicis longus and extensor pollicis brevis tendons as they pass under the extensor retinaculum.
- Clinical features
Hallmark, and the diagnostic criterion: pain at the radial base of the thumb reproduced by the Finkelstein test, performed by flexing the thumb into the palm, closing the fingers over the thumb, and…
- Differential diagnosis
Disseminated gonococcal infection: presents with a triad of tenosynovitis, dermatitis (pustular/purpuric skin lesions), and polyarthralgia in a sexually active patient, distinguished from de Quervain…
- Diagnosis
How the diagnosis is made: de Quervain tendinopathy is a clinical diagnosis established by radial-sided wrist/thumb-base pain reproduced on the Finkelstein test (thumb flexed into the palm, fingers…
- Management
First, start conservative first-line care: rest, ice, and a thumb spica splint to immobilize the first dorsal compartment, combined with an oral NSAID such as naproxen 500 mg PO twice daily with food for 2 to 4 weeks.
- Complications
Persistent pain and functional limitation: ongoing thumb and wrist pain with gripping or pinching if the tendinopathy is not adequately treated.
- Prognosis
Most patients improve with conservative care: the majority of cases resolve with rest, NSAIDs, and splinting, or with the addition of a single corticosteroid injection.
- Prevention
Modify the provoking activity: reduce repetitive ulnar-deviated gripping and pinching, such as prolonged handheld-device use or repetitive infant-lifting technique with a thumb-out grip, the specific…
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