De Quervain's Tenosynovitis✅

Question 1

Mechanism of injury of De Quervain’s Tenosynovitis

Answer 1

Cumulative microtrauma –> tenosynovitis of abductor pollicis longus + extensor pollicis brevis (radial side of thumb)

Question 2

Causes of De Quervain’s Tenosynovitis

Answer 2

• Pregnant women –> increase in water content within connective tissue (e.g. extensor retinaculum of hand) –> compress the 2 thumb tendons
• Parents of new born babies –> lots of ulnar deviation, thumb extension and abduction
• The wrist being held in an awkward position in pinching or peeling
• Repeated resistive thumb motion, e.g. cutting with scissors
• Gripping with the fingers and twisting of the wrist, e.g. wringing towels, scrubbing surfaces

Question 3

Special test

Answer 3

Finkelstein’s test (flex thumb into palm of hand –> ulnar deviate the wrist)

Question 4

Tx of De Quervain’s Tenosynovitis

Answer 4

• thumb spica splint (wrist neutral, thumb in opposition, free thumb IPJ)
• Education on modifying your daily activities to avoid the overuse of your thumb and wrist (awkward thumb positioning or forceful gripping / pinching)
• As the pain subsides, start gentle wrist and thumb exercises to prevent stiffness