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De Quervain Syndrome

(De Quervain's Syndrome; Washerwoman’s Sprain)

By

David R. Steinberg

, MD, Perelman School of Medicine at the University of Pennsylvania

Last full review/revision Apr 2022| Content last modified Sep 2022
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De Quervain syndrome is stenosing tenosynovitis of the short extensor tendon (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 with rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that primarily involves the joints. RA causes damage mediated by cytokines, chemokines, and metalloproteases. Characteristically... read more Rheumatoid Arthritis (RA) . It commonly manifests in parents of newborns because of repetitive lifting with wrists in radial deviation.

The major symptom of De Quervain syndrome 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 of De Quervain syndrome 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. A positive hitchhiker's maneuver (pain elicited along first extensor compartment during resisted thumb extension) is also highly suggestive.

Treatment of De Quervain Syndrome

  • Corticosteroid injection

  • Thumb spica splint

  • Sometimes surgery

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. Ultrasonographic guidance is sometimes used.

Surgical release of the first extensor compartment is very effective when conservative therapy fails.

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