Philippine National Police General Hospital

Department of Orthopedic Surgery

DE QUERVAINS
TENOSYNOVITIS

Joaquin L. Guillermo Jr. MD

Post-Grad Intern

CASE
55 y/o
Female
NUP- Desk jobs
Non-smoker
Non-alcohol beverages
drinker

c/c: Wrist pain, left x 4 weeks

ROS: Unremarkable
PE: Extremities: (+) Palpable
mass on the radial aspect of
the wrist L, movable, non
tender
(+) Pain on the thumb
upon motion
(+) Crepitus

MANAGEMENT
Was referred to PMRS
Conservative
management was done
Thumb Spica splint
Cold Modalities
AROM exercises
Transverse Friction
Galvanic ES
Iontophoresis

ON FOLLOW-UP
After 6th therapy sessions, pain decreased but was
persistent.
Corticosteroids was given for 2 sessions with one month
interval

 Failure= Surgical Intervention

Surgical release of the 1st compartment

DISCUSSION
Fritz de Quervain 1895
Stenosing tenosynovitis of the 1st dorsal
compartment of the wrist
Most common- entrapment tendinitis of the
hand and wrist- trigger digit
2nd MC is de Quervains

RISK FACTORS
Pregnancy/ Post Partum
Work- related washer womans hand
s/p Mastectomy
30th-60th decade of life
6x more common in Females

rd

4th

th

6th

2nd

1st

Radius

Uln
a

ANATOMY

1st
DC

APL, EPB

2nd DC

ECRL/B

3rd DC

Extensor pollicis longus

4th DC

extensor digitorum
communis and extensor
indicis proprius

5th DC

extensor digiti minimi

6th DC
extensor carpi ulnaris
Extensor Retinaculum

PRESENTATION
Pain on the wrist weeks- months, along the radial aspect
of the wrist
Aggravated by thumb motion
Lump/mass 1-2 cm proximal to the styloid process
No tenderness proximal to the 1st compartment

DDX
Ganglion of the extensor retinaculum
OA of the thumb CMC joint
Carpal Tunnel Syndrome
Scaphoid fracture
Intersection Syndrome
Tuberculous Tenosynovitis

DIAGNOSTICS

Finkelsteins
Test

MANAGEMENT
Conservative

Surgical

Rehabilitation
Thumb Spica splint
Corticosteroids
Transverse Friction

Release of the 1st dorsal

compartment

SURGICAL
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THANK YOU!!!