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De Quervain Syndrome
De Quervain syndrome is stenosing tenosynovitis of the short extensor (extensor pollicis brevis) and long abductor tendon (abductor pollicis longus) of the thumb within the first extensor compartment.
De Quervain syndrome usually occurs after repetitive use (especially wringing) of the wrist, although it occasionally occurs in association with RA. The major symptom is aching pain at the wrist and thumb, aggravated by motion. Tenderness can be elicited just proximal to the radial styloid process over the site of the involved tendon sheaths. Diagnosis is highly suggested by the Finkelstein test. The patient adducts the involved thumb into the palm and wraps the fingers over the thumb. The test is positive if gentle passive ulnar deviation of the wrist provokes severe pain at the affected tendon sheaths.
Rest, warm soaks, and NSAIDs may help in very mild cases. Local corticosteroid injections and a thumb spica splint help 70 to 80% of cases. Tendon rupture is a rare complication of injection and can be prevented by confining infiltration to the tendon sheath and avoiding injection of the corticosteroid into the tendon. Intratendinous location of the needle is likely if injection is met with moderate or severe resistance. Surgical release of the first extensor compartment is very effective when conservative therapy fails.
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