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 and extensor pollicis brevis 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.
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- 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