De Quervain’s Syndrome

Definition

Stenosing Tenosynovitis of 1st dorsal compartment of wrist

Aetiology

  • Repetitive thumb abduction with wrist ulnar deviation
  • Postpartum and lactating women, linked to lifting an infant
  • Direct trauma to the radial styloid
  • Inflammatory arthritis
  • Separate EPB subcompartment predisposes to stenosis

Epidemiology

  • Most are middle-aged women
  • Can develop in any with repetitive thumb abduction & extension combined with RD & UD movements
  • Results from any mechanical irritation of foreign body, prominent bony surface, restricted fascial comp or abnormal muscle insertion to epitenon

Associated Conditions

  • DM
  • Pregnancy
  • Hypothyroidism
  • Gout
  • Pseudogout
  • RA
  • Osteoarthritis
  • PostTrauma
  • TB
  • Vascular disease

Anatomy

  • 1st dorsal compartment runs over styloid process
  • Runs in osteoligamentous tunnel of shallow groove in styloid & roofed by dorsal ligament attached by fibrous septa to bone
  • Tunnel ~ 1cm long
  • 1x APL & 1x EPB in only 20%
  • 20-30% divided by vertical septa into 2 comps
    • Ulnar for EPB
    • Other for one or more slips of APL
  • EPB phylogenetically young muscle
    • Found only in humans & gorillas as separate from APL
    • EPB absent 5-7%
  • Larger APL has (up to 75%) 2-3 or more tendinous slips inserting variously into
    • Base of 1st MC
    • Trapezium
    • Volar carpal ligament
    • Opponens pollicis
    • APB

Pathology

  • Thickening of the extensor retinaculum over the first dorsal compartment
  • Stenosis of the APL and EPB tendon sheath
  • Myxoid degeneration and fibrocartilaginous metaplasia with little inflammatory infiltrate

Classification

  • No accepted severity classification in clinical use
  • Anatomical variants relevant to treatment include a separate EPB subcompartment
  • Multiple APL tendon slips

History

  • Radial wrist pain over the radial styloid with thumb use
  • Pain with gripping, pinching and lifting
  • Swelling over the first dorsal compartment
  • Middle aged and postpartum women
  • Occupation and hobbies with repetitive thumb movement

Examination

  • Pain & swelling over styloid
  • May radiate proximal & distal
  • Finkelstein’s test +ve
  • Crepitus
  • Occasionally see triggering
  • RD posture
  • May have Bone Scan +ve

Investigations

De Quervain's Syndrome, finkelstein test for de quervain tenosynovitis
Finkelstein test for De Quervain tenosynovitis. Image by en:User InvictaHOG, Wikimedia Commons, Public domain.
  • Clinical diagnosis
  • X-rays exclude thumb CMC arthritis, scaphoid pathology and radial styloid lesions
  • Ultrasound shows retinacular thickening, sheath fluid and intracompartmental septum
  • Ultrasound guides injection into each subcompartment

Differential Diagnosis

  • Basilar thumb arthrosis
  • Scaphoid nonunion
  • Intersection syndrome (ECRL/B crossed by APL & EPB)
  • Wartenberg’s Syndrome (compression superficial branch radial n)

Treatment

Non-op

  • Rest & Splint
  • HCLA
    • Harvey 71% relief with 1x injection
    • Only 11% need surgery
  • Prolonged conservative Treatment if condition involves pregnancy, DM etc

Operative

  • Transverse or Longitudinal incision
  • Blunt dissection to expose Superficial Radial Nerve
  • Divide Annular Ligament » ensure all compartments decompressed

Complications

  • Very Common
  • 2 papers ~ 100%
  • Radial n neuroma/ division
  • Hypertrophic scar from longitudinal incision
  • Volar subluxation of tendon if remove too much sheath

Prognosis

  • Most resolve after one or two corticosteroid injections
  • Separate EPB subcompartment is linked to injection failure
  • Surgical release gives high rates of symptom relief

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.