dequrvain tenosynovitis introduction sign and symptom examination treatment

1. HamidReza Zafari
Orthopaedic surgery resident at Tehran university Medical scince
Imam Khomeyni Hospital center
Dequrvain Tenosynovitis

2.  A 32-year old, right hand dominant female presented
with gradual onset over four months of right-sided
radial wrist pain. The patient was a stay at home
mother. Her pain started after pulling her two
children (boys aged seven months and three years
old) in a wagon during her daily walks. She originally
felt only mild discomfort in the right wrist and base
of the thumb that did not limit any of her activities of
daily living (ADLs).
 Over the following weeks, she noticed a gradual
increase in her wrist and thumb pain, especially after
holding her seven-month old son at her side

3.  Finkelstein stated
that this test is
“probably the most
pathognomonic
objective sign,” it is
not diagnostic

4.  Diagnosed is mainly through clinically
 Wrist imaging is required only in the
presence of associated processes such as
previous distal radius or scaphoid fracture,
arthritis of the thumb, and instability of the
wrist

5. DE QUERVAIN DISEASE

6.  De Quervain syndrome is stenosing
tenosynovitis of the
short extensor tendon (EPL)
long abductor tendon (APL)
of the thumb within the first extensor
compartment.
 30 to 50 years (Female > Male )

7.  The APL originates on the
distal third of the radius and
has multiple slips (2 to 4),
with variable insertions on
the base of the thumb
metacarpal and trapezium.
 The primary function of the
APL is to abduct the thumb
and assist with radial
deviation of the wrist

8.  The EPB originates on the
dorsal surface of the radius
and the interosseous
membrane and inserts on the
base of the proximal phalanx
of the thumb.
 The EPB functions to
extend the
metacarpophalangeal joint
and to weakly abduct the
thumb

11. Conservative Treatment
 Nonsurgical treatment should
be the first course of action for
de Quervain disease.
 The patient presenting with mild
to moderate pain that does not
limit activities of daily living may
be treated with -
 Rest
 Splinting

12. Medical management
• Corticosteroid injection: can be
given to patient with morderate to
marked pain with symptoms
lasting for more than 3 weeks.
• NSAIDS : it is precribed initially
for 6 to 8 weeks to reduce pain
and inflammation.

13.  When pain does not resolve after
two corticosteroid injections and 6
months of nonsurgical
management, then surgical release
of the first dorsal compartment is
recommended.

14.  Under local anesthesia, with or without
intravenous sedation, and tourniquet control,
a transverse or oblique incision is given over
radial styloid

15.  The skin is retracted and careful blunt
dissection will reveal branches of the radial
sensory nerve in the subcutaneous tissue
 Radial sensory nerve is identified and
protected with blunt retractors

17.  The small pressure dressing is removed after 48
hours
 Thumb and hand motion is immediately
encouraged and is increased as tolerated
except for forceful wrist flexion
POSTOPERATIVE CARE

18. Complications :
 Radial sensory nerve injury
 Incomplete decompression,
 Volar subluxation of the tendons

19.  Anatomic variations are common in the
first dorsal compartment
 Reports of separate compartments
found at surgery vary from 20% to
58%.
 More than half of patients may have
“aberrant” or duplicated tendons
(usually the abductor pollicis longus)
.
 These tendons sometimes insert more
proximally and medially than usual,
into the trapezium (Fig. 76-14)