De Quervain Syndrome
(De Quervain's Syndrome; Washerwoman’s Sprain)
(See also Overview and Evaluation of Hand Disorders.)
De Quervain syndrome usually occurs after repetitive use (especially wringing) of the wrist, although it occasionally occurs in association with rheumatoid arthritis. 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.
Rest, warm soaks, and nonsteroidal anti-inflammatory drugs (NSAIDs) may help in very mild cases of De Quervain syndrome.
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.