De Quervain's Tenosynovitis
Aetiology
- Painful inflammation of EPL and APB tendons of the thumb in
tendon sheath.
- Overuse, repetitive pinching or grasping cause inflammation
- Histolgy: myxoid degeneration & chronic inflammation, with scar formation and stenosis of the approximately 1cm section of the fibro-osseous tunnel.
- 1895 Fritz de Quervain (swiss)
Symptoms
- Pain in distal radial forearm may radiate to thumb or proximally
- F:M = 8:1
- Check for crepitus over tendon sheaths
- Finklestein's test positive
- Classically in mothers of infants or manual labourers
- Finklestein's test helps differentiate from intersection
syndrome
Treatment
- Treat acute episode with thumb immobilisation and NSAIDs
- May require PoP for 1/12
- No evidence to support steroid injections in acute cases [BestBets]
- Check rheumatoid autoantibody screen in persistent
cases
- More chronic cases warrant a trial steroid injection
- Surgical release of tendon sheath occasionally required
