Definition
Stenosing tenosynovitis of the first dorsal compartment of wrist
- APL and EPB
- associated with thumb movement
Epidemiology
Middle aged women
Anatomy
| 1st dorsal compartment | APL | EPB |
|---|---|---|
| Over shallow groove in radial styloid |
Inserts base of 1st metacarpal - +/- trapezium / APB / opponens pollicis |
Inserts base of P1 |
|
Osseoligamentous tunnel - 1 cm long - roof of dorsal ligament - attached by fibrous septa to bone |
75% of population have 2 tendons | Absent 5% of population |
|
20% have two separate compartments - septum - associated with De Quervain's |
Etiology
Repetitive thumb movements
- golf / tennis
- typing / knitting
Associations - RA/ Gout / DM / Pregnancy / Hypothyroidism
Anatomical variations
- two APL tendons
- septum dividing 1st extensor compartment into two
Thicker tendon sheath of 1st extensor compartment
Clinical Features
Pain / swelling / crepitis over radial styloid / first dorsal compartment
- repetitive gripping / pinching
- using the thumb
| Finkelstein's test | Eichoff maneuver |
|---|---|
|
Grasp patient thumb Ulna deviate wrist |
Patient grasps own thumb Ulna deviation of wrist |
 |
 |
X-ray
Exclude base of thumb OA
Look for bony spur that may need resection
DDx
Wartenberg's Syndrome - compression superficial branch radial nerve
Intersection syndrome - ECRL/B crossed by APL & EPB
Nonoperative management
Splints
Cevik et al Hand Surg Rehab 2024
- systematic review of splints for de Quervains
- cortisone superior to splint
- addition of splint to cortisone improves outcomes
Extra Corporeal Shock Wave
Chong et al J Hand Surg Am 2024
- systematic review of RCTs
- evidence for efficacy of shock wave in De Quervain's
Injections
Cortisone
- systematic review of cortisone injections for de Quervains
- 74% resolution of symptoms (18% of these recurred)
Hyaluronic acid
- RCT of cortisone v cortisone + HA
- improved outcomes with addition of HA
PRP
Hidajat et al World J Orthop 2024
- systematic review of PRP for de Quervains
- evidence for pain reduction at 1 and 6 months
Chowley et al J Hand Surg 2025
- RCT of cortisone v PRP for de Quervains in 86 patients
- similar outcomes
- cortisone more effective early
Operative management
Options
Open release
Endoscopic release
US guided release
Open technique
Vumedi open transverse De Quervain's release video
Vumedi open longitudinal De Quervain's release video
Incisions
- proximal / inline with radial styloid
- longitudinal protects nerve
- transverse gives better scar
- identify and protect superficial radial nerve
Open compartment and release tendons
- including sheaths / separate compartments
- assess floor of compartment for pathology
Compartment release options
1. Divide compartment on ulna side to prevent radial instability
2. Z lengthen and loosely repair fascial roof to prevent subluxation
3. Partial resection / division
Results
Outcomes
Bosman et al Plast Recon Surg 2022
- systematic review of De Quervain's release in 900 patients
- 95% successful
- complications 11%
Incisions
Suwannaphisit et al BMC Musculoskeletal 2024
- RCT of 70 patients transverse v longitudinal incisions
- no difference in outcomes
Pulley release v pulley reconstruction
- RCT of pulley release v pulley reconstruction in 40 cases
- increased tendon subluxation with pulley release
- no difference in outcomes
Open v endoscopic release
- RCT of open v endoscopic release in 50 patients
- no difference in outcomes at 6 months
- less early pain with endoscopic
- fewer nerve injury and better scar with endoscopic
Complications
Radial nerve neuroma
Hypertrophic scar from longitudinal incision
Ongoing pain / inadequate release
Tendon subluxation
Renson et al J Wrist Surg 2018
- 10 patients with symptomatic tendon instability after De Quervain's release
- reconstruction of the pulley with extensor retinaculum
- 6/10 poor functional outcome
Vumedi pulley reconstruction for symptomatic tendon instability after De Quervain's release video