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De Quervain's Tenosynovitis: Dr. Jatin JR3 Year Orthopaed Ics Fmhs Under SGT University
De Quervain's Tenosynovitis: Dr. Jatin JR3 Year Orthopaed Ics Fmhs Under SGT University
Quervain’s
Tenosynovitis
Dr. Jatin
JR 3rd year
Orthopaed
ics
FMHS
under SGT
University
INTRODUCTION
• It is named after Swiss surgeon, FRITZ DE
QUERVAIN who first described the condition
in 1895.
• It is a stenosing tenosynovitis which
affects the tendon sheaths of the 1st dorsal
compartment of the wrist.
• It is characterised by degeneration
and fibrosis of the tendon sheath.
Incidence
• Occurs most often in individuals age between
30 and 50 years
• It affects women up to six times more
often than men
• Is commonly associated with dominant
hand
Ananto
The dorsal aspect
my of the wrist contains six
compartments that transmit the tendons to the
hand.
• 1-Abd. Pollicis longus
Ext. pollicis brevis
• 2- Ext.carpi radialis
longus Ext. carpi
radialis brevis
• 3- Ext. pollicis longus
• 4-Ext.
digitorum
Ext. indicis
• 5- Ext. digiti
First Dorsal Compartment
Increases friction
Reactive fibrosis and thickening of the sheath.
Degeneration.
Clinical Features
• Patient may complain
pain on the radial side
of the wrist that is
worsened by moving
the wrist or thumb.
• Sometimes there is a
visible swelling over the
radial styloid.
• The tendon sheath may feels thick and
hard.
• Tenderness is mostly acute at the tip of
the radial styloid.
• Pain aggravates on grasping and raising
objects with the wrist
• Wet leather sign
• The Finkelstein test is positive.
Finkelstein test
• It is a provocative test used in diagnostic for de Quervain's
tenosynovitis.
• Makes a fist with
the thumb inside.
• Now ask the patient
to bend the wrist
toward little finger
Differential
Diagnosis
• CMC arthritis of the thumb: pain and crepitus
present with the thumb "crank and grind test .
• Scaphoid fracture: in this tenderness will be in the
anatomic snuff box.
• Chauffeur's fracture
• Intersection syndrome-tenosynovitis of the second
dorsalcompartment involving the tendons of
extensor carpi radialis brevis (ECRB) and extensor
carpi radialis longus (more proximal pain)
• Extensor pollicis longus (EPL) tendonitis of the third dorsal
compartment: common in patients with rheumatoid arthritis
or with direct injury and distal radius fracture .
TREATMENT
GOALS
I. Restoration of normal,painless use of the involved
hand.
II. Resolution of the inflammatory process.
III. Prevention of recurrence of the through
education.
IV. Restoration of pain-free movements
and strength .
CONSERVATIVE MANAGEMENT
Medical management
• Corticosteroid injection: can be
given to patient with morderate to
marked pain with symptoms
lasting for more than 3 weeks.