{"id":16221,"date":"2023-04-24T16:25:52","date_gmt":"2023-04-24T14:25:52","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=condition&#038;p=16221"},"modified":"2024-05-20T19:41:57","modified_gmt":"2024-05-20T17:41:57","slug":"de-quervains-tenosynovitis","status":"publish","type":"condition","link":"https:\/\/www.physiotutors.com\/conditions\/de-quervains-tenosynovitis\/","title":{"rendered":"De Quervain&#8217;s Tenosynovitis"},"featured_media":16223,"template":"","class_list":["post-16221","condition","type-condition","status-publish","has-post-thumbnail","hentry"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":16223,"background_image_alt_text":"De Quervain's Tenosynovitis"},"heading":"De Quervain's Tenosynovitis | Diagnosis & Treatment","subheading":"Wrist & Hand","content_editor":"","button_type":"url","button_label":"","button_style":"button-five","button_internal_link":4646,"button_anchor":"","button_url":"https:\/\/study.physiotutors.com\/course\/wristhand\/","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Introduction & Epidemiology","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Clinical Picture & Examination","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Treatment","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Wrist & Hand Online Course","button_internal_link":null,"button_anchor":"section-number-6","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Course Reviews","button_internal_link":null,"button_anchor":"section-number-7","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":22104,"button_anchor":"","button_url":"","button_file":""},"button_description":""},{"acf_fc_layout":"content-with-sidebar","content_editor":"<h1>De Quervain's Tenosynovitis | Diagnosis &amp; Treatment<\/h1>\r\n<h3>Introduction<img class=\"wp-image-12029 alignright\" src=\"https:\/\/physiotutors.com\/wp-content\/uploads\/study\/2017\/02\/de-quervain-587x1024.jpg\" alt=\"\" width=\"269\" height=\"469\" \/><\/h3>\r\nDe Qu\u00e9rvain\u2019s disease or de Qu\u00e9rvain stenosing tenosynovitis involves irritation of the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) within the first dorsal compartment of the hand as they pass through a swollen extensor retinaculum (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26510626\" target=\"_blank\" rel=\"noopener noreferrer\">Adams et al. 2015<\/a>).\r\n\r\nIt is commonly assumed that repetitive overload of the wrist and thumb is the cause of the disease. This includes activities involving repetitive ulnar deviation such as hammering, cross-country skiing, or lifting (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9343764\" target=\"_blank\" rel=\"noopener noreferrer\">Moore 1997<\/a>, <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26510626\" target=\"_blank\" rel=\"noopener noreferrer\">Adams et al. 2015<\/a>).\r\n\r\nRisk factors for the condition include:\r\n<ul>\r\n \t<li>Female gender<\/li>\r\n \t<li>Age 35 \u2013 55<\/li>\r\n \t<li>Pregnancy or postpartum and lactation<\/li>\r\n \t<li>Arthritic changes of the first metacarpal<\/li>\r\n \t<li>Diabetes, rheumatoid arthritis, gout<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<h3><strong>Epidemiology <\/strong><\/h3>\r\nThe prevalence of the condition in the general population is estimated at 5\/1000 persons in males and 13\/1000 persons in females. It predominantly occurs in women between the age of 35 \u2013 55 and mostly during or after pregnancy. The latter may have to do with higher estrogen receptor-\u03b2 expression (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4661827\/\" target=\"_blank\" rel=\"noopener noreferrer\">Shen et al. 2015<\/a>).\r\n\r\nFurthermore, there seems to be a correlation between degenerative conditions such as arthritis of the first metacarpal and de Qu\u00e9rvains disease (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24005369\" target=\"_blank\" rel=\"noopener noreferrer\">Stahl et al. 2013<\/a>, <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21663848\" target=\"_blank\" rel=\"noopener noreferrer\">Andreu et al. 2011<\/a>)."},{"acf_fc_layout":"content-with-sidebar","content_editor":"<h2><strong>Clinical Presentation &amp; Examination<\/strong><\/h2>\r\n<h3><span style=\"color: #000000;\"><strong>Signs &amp; Symptoms<\/strong><\/span><\/h3>\r\nThe hallmark symptom is pain at the radial side of the wrist. This is aggravated during activities that involve ulnar deviation (with a closed fist). Thumb function is also limited due to pain. Furthermore, swelling may be present around the radial styloid process (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4349843\/\" target=\"_blank\" rel=\"noopener noreferrer\">Goel et al. 2015<\/a>).\r\n\r\n&nbsp;\r\n<h3><strong>Examination<\/strong><\/h3>\r\nTypically, the history and physical presentation of the condition provides enough diagnostic value. There are two diagnostic tests described in the literature.\r\n\r\nThe <a href=\"https:\/\/www.physiotutors.com\/wiki\/finkelstein-test\/\">Finkelstein test<\/a> is the hallmark test to diagnose de Quervain's tenosynovitis although no values and validity are known. So the clinical value of this test is questionable.\r\n\r\nTo perform the test <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20709467\/\" target=\"_blank\" rel=\"noopener\">Dawson et al. (2010)<\/a> recommend a three-stage process that is well tolerated and able to diagnose de Quervain's tenonitis accurately. To perform the test, have your patient's affected extremity extended so that the wrist remains at the edge of the treatment table the arm is positioned with the ulnar aspect of the forearm on the table, and the ulnar aspect of the hand hanging off of the edge. The forearm is maintained in neutral.\r\n\r\nIn the first step, the patient's pain is assessed with gravity-assisted gentle active ulnar deviation at the wrist. This version is suitable for patients who present in the acute phase. This test is positive if the patient reports pain aggravation at the tip of the styloid process.\r\n\r\nIf version one does not elicit pain, gently apply a deviation force to the hand which results in an increased passive stretch across the first dorsal compartment. Again, this test is positive if the patient reports aggravated pain over the styloid process.\r\n\r\nIf the second step is still not provoking, we will perform the original version described by Finkelstein et al. which is suitable for patients in the chronic stage that are unlikely to experience substantial pain in the first two steps. In this third step, grasp the thumb and then passively flex it into the palm.\r\n\r\nA positive test result is recorded if the patient experiences increased pain over the tip of the styloid process. Performing the test in this stage manner is hypothesized to create fewer false positive results as it is less provocative than the <a href=\"https:\/\/www.physiotutors.com\/wiki\/eichhoffs-test\/\">Eichhoff test<\/a> which is often confused with the <a href=\"https:\/\/www.physiotutors.com\/wiki\/finkelstein-test\/\">Finkelstein test<\/a>.\r\n<div class=\"embed-container\">\r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=8WBVXBx34W0[\/embed]\r\n\r\n<\/div>\r\nIn the literature, there's a lot of confusion regarding the original version of the <a href=\"https:\/\/www.physiotutors.com\/wiki\/finkelstein-test\/\">Finkelstein test<\/a>. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/1402284\/\" target=\"_blank\" rel=\"noopener\">Elliot et al. (1992)<\/a> state that over the last three decades an error in performing Finklestein's test has crept into the English literature in textbooks and journals. This error can produce a false positive and if relied upon a wrong diagnosis can be made leading to inappropriate surgery. The error that has crept into the literature is actually <a href=\"https:\/\/www.physiotutors.com\/wiki\/eichhoffs-test\/\">Eichhoff's test<\/a>. Because no validity studies have\u00a0ever been conducted for this test its clinical\u00a0use is questionable.\r\n\r\nTo perform this test have your patient extend his affected extremity and rest it on the treatment table so that the wrist is hanging off the table. Then, ask him to make a fist with the thumb inside his fist, stabilize the forearm on the table and gently deviate the wrist towards the ulnar side.\r\n\r\nThis test is positive if your patient experiences\u00a0pain over the tendons of the extensor pollicis\u00a0brevis and abductor pollicis longus which both\u00a0form the medial base of the anatomical snuffbox.\r\nDue to its very provocative nature, <a href=\"https:\/\/www.physiotutors.com\/wiki\/eichhoffs-test\/\">Eichhoff's test<\/a> can cause a lot of false positives which is why we recommend rather to perform the original version of the Finkelstein test.\r\n<div class=\"embed-container\">\r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=l_9Suv0xhmY[\/embed]\r\n\r\n<\/div>\r\n[cta]"},{"acf_fc_layout":"content-with-sidebar","content_editor":"<h2><strong>Treatment<\/strong><\/h2>\r\nNon-surgical treatment is advised as a first-line intervention. Here the best available intervention is corticosteroid injection with optional supportive splinting. Reducing aggravating activities until symptoms subside is advised. Severe cases that last longer than six months may undergo surgical release of the first dorsal compartment (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4655850\/\" target=\"_blank\" rel=\"noopener\">Rowland et al. 2015<\/a>, <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25762881\/\" target=\"_blank\" rel=\"noopener\">Goel et al. 2015<\/a>, <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18063716\/\" target=\"_blank\" rel=\"noopener\">Ilyas et al. 2007<\/a>)\r\n\r\nDo you want to learn more about conditions of the wrist &amp; hand? Then check out our other resources:\r\n<ul>\r\n \t<li><a href=\"https:\/\/www.physiotutors.com\/podcasts\/episode-24-wrist-and-elbow-injuries-in-combat-sports-with-ian-gatt\/\">Wrist &amp; Elbow Injuries in Combat Sports with Ian Gatt<\/a><\/li>\r\n \t<li><a href=\"https:\/\/study.physiotutors.com\/course\/wrist-elbow-injuries-in-sports-optimizing-our-approach\">Wrist &amp; Elbow Injuries in Sports with Ian Gatt (Webinar)<\/a><\/li>\r\n \t<li><a href=\"https:\/\/www.physiotutors.com\/carpal-tunnel-syndrome\/\">Carpal Tunnel Syndrome Guest Blog by Sian Smale<\/a><\/li>\r\n<\/ul>\r\n&nbsp;\r\n<h2><strong>References<\/strong><\/h2>\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26510626\" target=\"_blank\" rel=\"noopener noreferrer\">Adams, Julie E., and Rohan Habbu. \"Tendinopathies of the hand and wrist.\"\u00a0<i>JAAOS-Journal of the American Academy of Orthopaedic Surgeons<\/i>\u00a023.12 (2015): 741-750.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21663848\" target=\"_blank\" rel=\"noopener noreferrer\">Andr\u00e9u, Jos\u00e9-Luis, et al. \"Hand pain other than carpal tunnel syndrome (CTS): the role of occupational factors.\"\u00a0<i>Best Practice &amp; Research Clinical Rheumatology<\/i>\u00a025.1 (2011): 31-42.<\/a>\r\n\r\n<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20709467\/\" target=\"_blank\" rel=\"noopener\">Dawson, C., &amp; Mudgal, C. S. (2010). Staged description of the Finkelstein test.\u00a0<i>The Journal of hand surgery<\/i>,\u00a0<i>35<\/i>(9), 1513-1515.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1402284\" target=\"_blank\" rel=\"noopener noreferrer\">Elliott, B. G. (1992). Finkelstein\u2019s test: a descriptive error that can produce a false positive.\u00a0<i>Journal of hand Surgery<\/i>,\u00a0<i>17<\/i>(4), 481-482.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4349843\/\" target=\"_blank\" rel=\"noopener noreferrer\">Goel, Ritu, and Joshua M. Abzug. \"de Quervain's tenosynovitis: a review of the rehabilitative options.\"\u00a0<i>Hand<\/i>\u00a010.1 (2015): 1-5.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18063716\/\" target=\"_blank\" rel=\"noopener noreferrer\">Ilyas, Asif M., et al. \"De quervain tenosynovitis of the wrist.\"\u00a0<i>JAAOS-Journal of the American Academy of Orthopaedic Surgeons<\/i>\u00a015.12 (2007): 757-764.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11386780\" target=\"_blank\" rel=\"noopener noreferrer\">Lane, L. B., R. S. Boretz, and S. A. Stuchin. \"Treatment of de Quervain\u2019s disease: role of conservative management.\"\u00a0<i>Journal of Hand Surgery<\/i>26.3 (2001): 258-260.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9343764\" target=\"_blank\" rel=\"noopener noreferrer\">Moore, J. Steven. \"De Quervain's tenosynovitis: stenosing tenosynovitis of the first dorsal compartment.\"\u00a0<i>Journal of occupational and environmental medicine<\/i>\u00a039.10 (1997): 990-1002.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4655850\/\" target=\"_blank\" rel=\"noopener noreferrer\">Rowland, Patrick, et al. \"The effectiveness of corticosteroid injection for de Quervain\u2019s stenosing tenosynovitis (DQST): A Systematic Review and meta-analysis.\"\u00a0<i>The open orthopaedics journal<\/i>\u00a09 (2015): 437.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4661827\/\" target=\"_blank\" rel=\"noopener noreferrer\">Shen, Po-Chuan, et al. \"The Estrogen Receptor-\u03b2 Expression in De Quervain\u2019s Disease.\"\u00a0<i>International journal of molecular sciences<\/i>\u00a016.11 (2015): 26452-26462.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24005369\" target=\"_blank\" rel=\"noopener noreferrer\">Stahl, St\u00e9phane, et al. \"Systematic review and meta-analysis on the work-related cause of de Quervain tenosynovitis: a critical appraisal of its recognition as an occupational disease.\"\u00a0<i>Plastic and reconstructive surgery<\/i>\u00a0132.6 (2013): 1479-1491.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7963313\" target=\"_blank\" rel=\"noopener noreferrer\">Weiss, Arnold-Peter C., Edward Akelman, and Mehra Tabatabai. \"Treatment of de Quervain's disease.\"\u00a0<i>Journal of Hand Surgery<\/i>\u00a019.4 (1994): 595-598.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1993717\" target=\"_blank\" rel=\"noopener noreferrer\">Witt, J. O. H. A. N., G. A. R. Y. Pess, and R. H. Gelberman. \"Treatment of de Quervain tenosynovitis.\"\u00a0<i>J Bone joint surg AM<\/i>\u00a073 (1991): 219-22.<\/a>"},{"acf_fc_layout":"cta-special","heading":"Increase your confidence in assessing and treating the Hand & Wrist","subheading":"Online Course","button_type":"url","button_label":"Learn More","button_style":"button-link-one","button_internal_link":null,"button_anchor":"","button_url":"https:\/\/study.physiotutors.com\/course\/wristhand\/","button_file":null,"image":{"image_image":14461,"image_image_alt_text":"Elbow Course"},"background":{"background_image":8702,"background_image_alt_text":"Physiotherapy online course"}},{"acf_fc_layout":"slider-reviews-wp-review-slider-pro","heading":"What customers have to say about this course","subheading":"Reviews","content":"[wprevpro_usetemplate tid=\"25\"]"}]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>De Quervain&#039;s Tenosynovitis | 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