EpistemisDe Quervain's tenosynovitis
Specialty: Musculoskeletal.
Why it occurs
- Mechanical overload from repetitive movements of ulnar deviation and thumb grasping (e.g., lifting babies, typing on mobile devices)
- Hormonal changes during pregnancy and postpartum
- Direct trauma to the radial styloid
- Rheumatoid arthritis or other inflammatory arthropathies
- Anatomical variations (subcompartmentalization of the extensor brevis or abductor longus tendon)
Initial workup
Positive Finkelstein test in clinical examination | High-resolution ultrasound of the wrist (shows thickening of the abductor longus and extensor pollicis brevis tendon sheath, peri-tendinous effusion and double halo sign) | AP and lateral wrist x-ray to rule out trapeziometacarpal osteoarthritis (rizarthrosis).
red flags
Absolute inability to perform the thumb clamp associated with severe numbness on the dorsum of the first interdigital space, or local signs of acute infection of the synovial sheath.
Standard management
- Ibuprofen — 400 mg every 8 hours orally, adjuvant to immobilization with a spica splint for the thumb
- Ultrasound-guided local infiltration of triamcinolone acetonide — 10-20 mg inside the sheath of the first dorsal compartment; highly resolving if applied early
- Paracetamol (1 g every 8 hours orally for basal analgesia).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 5
- Treatment options
- 3