synonyms:1st extensor tenosynovitis, baby wrist, dequerivain's disease, dequarvain's tenosynovitis
DeQuarvain's Etiology / Epidemiology / Natural History
- Stenosing tenosynovitis of the 1st dorsal compartment of wrist.
- First dorsal compartment: contains the abductor pollicis longus (APL) and extensor pollis brevis (EPB) tendons.
- EPB frequently travels in a separate compartment which must be released during surgery.
DeQuarvain's Clinical Evaluation
- Pain/tenderness over the 1st dorsal compartment/radial aspect of wrist. Worsened with thumb movement.
- Finkelstein test=pain in 1st compartment when wrist is ulnarly deviated with thumb flexed in palm. Reproduction of the patients pain is diagnositc of de Quervain's Tenosynovitis. (Finkelstein H, JBJS 1930;12:509)
- Most common in women 30-50. New mothers, housekeepers, athletes requiring forceful grasping coupled with ulnar deviation or repetitive thumb use (golf, fly fishing, racquet sports, javelin).
DeQuarvain's Xray / Diagnositc Tests
- P/A, lateral and Roberts (hyperpronated) wrist films indicated to rule out thumb CMC arthritis. Evaluate for calcifications in the area of the first dorsal compartment as well as post-traumatic deformity of the radial styloid.
DeQuarvain's Classification / Treatment
- Acute: Thumb Spica Splint, nsaids, acitivity modification.
- Subacute (patients who have failed acute management): Corticosteriod injection into first dorsal compartment.
- Chronic (patients who have 2 or more injections): Surgical release of first dorsal compartment. The EPB frequently has separate compartment which must be released.
- CPT 25000: Incision, extensor tendon sheath, wrist (deQuervain's)
DeQuarvain's Associated Injuries / Differential Diagnosis
- Continued pain
- Superficial radial nerve palsy
- Tendinous adhesions
- Hypertrophic scarring
- Volar tendon subluxation
DeQuarvain's Follow-up Care
- Thumb spica splint for 6 weeks.
- Sutures removed at 10 day follow-up visit.
DeQuarvain's Review References