De Quervain's Tenosynovitis
What is it: De Quervian's Tenosynovitis is an inflammatory condition involving the abductor pollicis longus and extensor pollicis brevis tendons as they run along the radial side of the wrist. It is often related to overuse of the thumb.
How does it present: Patients may complain about pain and swelling along the radial side of the wrist, especially just proximal to the base of the thumb. It is often aggravated by any activity that requires thumb motion, especially abduction and making a fist. Common activities that bring on symptoms may be twisting a door handle or turning the steering wheel of a car.
Common exam findings: There may be swelling along the tendon sheath and tenderness to palpation. The Finkelstein's test may also be positive.
Tests and treatment: Diagnosis can be made clinically and further testing is not necessarily indicated. Treatment includes avoidance of aggravating activities and a thumb spica splint can be used for immobilization. Occupational therapy may be helpful and in many cases corticosteroid injection can decrease symptoms. In recurrent or difficult to treat cases, wrist x-rays may be helpful to evaluate for bony abnormalities of the radius that may predispose to the condition and in these cases surgical intervention may be considered.