de Quervain tendinopathy
- Rohit Aggarwal, MD, MSc
Rohit Aggarwal, MD, MSc
- Assistant Professor of Medicine, Division of Rheumatology and Clinical Immunology
- University of Pittsburgh
- David Ring, MD, PhD
David Ring, MD, PhD
- Associate Dean for Comprehensive Care
- Dell Medical School, University of Texas at Austin
de Quervain tendinopathy affects the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first extensor compartment at the styloid process of the radius (figure 1). It is characterized by pain or tenderness at the radial side of the wrist. Although de Quervain tendinopathy is often attributed to overuse or repetitive movements of the wrist or thumb, the cause is generally unknown.
The pathogenesis, clinical manifestations, diagnosis, and treatment of de Quervain tendinopathy are discussed here. An overview of the anatomy and basic biomechanics of the wrist is presented elsewhere. (See "Anatomy and basic biomechanics of the wrist".)
de Quervain tendinopathy is a common cause of wrist pain in adults. It is most common among women between the ages of 30 and 50 years of age, including a small subset of women in the postpartum period [1-3]. These women tend to develop symptoms about four to six weeks after delivery.
The etiology of de Quervain tendinopathy is not well-understood. In the past, it was frequently attributed to occupational or repetitive activities involving postures that maintain the thumb in extension and abduction. Mothers in the postpartum period are thought to be particularly at risk because of the mechanical stress on the thumb and wrist when lifting the baby. Hormonal causes and fluid retention have also been implicated in postpartum mothers. However, the evidence to support these hypotheses is limited and is largely based on observational data. In addition, the histopathology does not demonstrate inflammation but rather myxoid degeneration (disorganized collagen and increased cellular matrix) in patients referred for surgery .
de Quervain tendinopathy affects both the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) at the point where they pass through a fibro-osseous tunnel (the first dorsal compartment) from the forearm into the hand [5-7]. These tendons are responsible for bringing the thumb away from the hand as it lies flat in the plane of the palm (ie, radial abduction). Similar to trigger finger (or stenosing flexor tenosynovitis), this disease involves a noninflammatory thickening of both the tendons and the tunnel (or sheath) through which they pass.
- Schumacher HR Jr, Dorwart BB, Korzeniowski OM. Occurrence of De Quervain's tendinitis during pregnancy. Arch Intern Med 1985; 145:2083.
- Anderson BC. Office Orthopedics for Primary Care: Diagnosis and Treatment, 2nd ed, WB Saunders, Philadelphia 1999.
- Wolf JM, Sturdivant RX, Owens BD. Incidence of de Quervain's tenosynovitis in a young, active population. J Hand Surg Am 2009; 34:112.
- Clarke MT, Lyall HA, Grant JW, Matthewson MH. The histopathology of de Quervain's disease. J Hand Surg Br 1998; 23:732.
- Sheon RP, Moskowitz RW, Goldberg VM. Soft Tissue Rheumatic Pain: Recognition, Management, Prevention, 3rd, Williams & Wilkins, Baltimore 1996.
- de Quervain F. Uber eine Form von chronischer Tendovaginitis. Correspondenz-Blatt fur Schweizer Arzte 1895; 25:389.
- Minamikawa Y, Peimer CA, Cox WL, Sherwin FS. De Quervain's syndrome: surgical and anatomical studies of the fibroosseous canal. Orthopedics 1991; 14:545.
- Sato J, Ishii Y, Noguchi H. Clinical and ultrasound features in patients with intersection syndrome or de Quervain's disease. J Hand Surg Eur Vol 2016; 41:220.
- Bouche P. Compression and entrapment neuropathies. Handb Clin Neurol 2013; 115:311.
- Saplys R, Mackinnon SE, Dellon AL. The relationship between nerve entrapment versus neuroma complications and the misdiagnosis of de Quervain's disease. Contemp Orthop 1987; 15:51.
- Ilyas AM. Nonsurgical treatment for de Quervain's tenosynovitis. J Hand Surg Am 2009; 34:928.
- Lane LB, Boretz RS, Stuchin SA. Treatment of de Quervain's disease:role of conservative management. J Hand Surg Br 2001; 26:258.
- Ring D, Schnellen A. Patient-centered care of de Quervain's disease. J Hand Microsurg 2009; 1:68.
- Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J Hand Surg Am 1994; 19:595.
- Papa JA. Conservative management of De Quervain's stenosing tenosynovitis: a case report. J Can Chiropr Assoc 2012; 56:112.
- Goel R, Abzug JM. de Quervain's tenosynovitis: a review of the rehabilitative options. Hand (N Y) 2015; 10:1.
- Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-DeJong B. Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. BMC Musculoskelet Disord 2009; 10:131.
- Mehdinasab SA, Alemohammad SA. Methylprednisolone acetate injection plus casting versus casting alone for the treatment of de Quervain's tenosynovitis. Arch Iran Med 2010; 13:270.
- Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. J Hand Surg Am 2002; 27:322.
- Peters-Veluthamaningal C, van der Windt DA, Winters JC, Meyboom-de Jong B. Corticosteroid injection for de Quervain's tenosynovitis. Cochrane Database Syst Rev 2009; :CD005616.
- Kume K, Amano K, Yamada S, et al. In de Quervain's with a separate EPB compartment, ultrasound-guided steroid injection is more effective than a clinical injection technique: a prospective open-label study. J Hand Surg Eur Vol 2012; 37:523.
- McDermott JD, Ilyas AM, Nazarian LN, Leinberry CF. Ultrasound-guided injections for de Quervain's tenosynovitis. Clin Orthop Relat Res 2012; 470:1925.
- Mellor SJ, Ferris BD. Complications of a simple procedure: de Quervain's disease revisited. Int J Clin Pract 2000; 54:76.
- Ta KT, Eidelman D, Thomson JG. Patient satisfaction and outcomes of surgery for de Quervain's tenosynovitis. J Hand Surg Am 1999; 24:1071.
- Scheller A, Schuh R, Hönle W, Schuh A. Long-term results of surgical release of de Quervain's stenosing tenosynovitis. Int Orthop 2009; 33:1301.
- DIFFERENTIAL DIAGNOSIS
- Osteoarthritis of the trapeziometacarpal joint
- Intersection syndrome
- Radial sensory nerve entrapment
- Crystal-induced arthritis
- Overall approach
- Conservative therapy
- Glucocorticoid injection
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS