Dequervain’s TenosynovitisDz

Synonyms: deQuervain’s disease, stenosing tenosynovitis

ICD9 Codes: 727.04;
ICD10 Codes: M65.4

Definition: deQuervain’s tenosynovitis represents inflammation of the tendon sheath surrounding the abductor pollicis longus and extensor pollicis brevis muscles (see Hand and Wrist Pain). It generally develops after overuse of the involved muscles (e.g., repetitive grasping with the thumb against resistance).

Demographics: Commonly affects women more than men. It is one of the most common forms of occupational overuse syndrome. It is also common during pregnancy, postpartum, and in other instances where no history of overuse can be elicited.

Cardinal Findings: Patients typically present with pain and tenderness in the area about the radial styloid that is worsened with movement. Uncommonly, local swelling of the involved tendons is seen. The diagnosis may be confirmed with the Finkelstein test (see Evaluation of Musculoskeletal Complaints, Table 7), in which pain is elicited by stretching the involved tendons. To perform this test, the patient places the thumb inside a clenched fist and then moves or deviates the fist downward toward the ulnar side. Pain elicited with this maneuver suggests deQuervain’s tenosynovitis.

Therapy: Treatment is guided by severity and may include splinting (to protect against further overuse), administration of topical analgesia (e.g., ice), NSAIDs, or local injection of corticosteroids. Surgery is rarely indicated.

BIBLIOGRAPHY

Moore JS. deQuervain’s tenosynovitis. Stenosing tenosynovitis of the first dorsal compartment.J Occup Environ Med 1997;39:990–1002.PMID:9343764

Schumacher HR Jr, Dorwart BB, Korzeniavski OM. Occurrence of deQuervain’s tendinitis during pregnancy. Arch Intern Med 1985;145:2083–2084.PMID:4062462