De Quervain’s Syndrome

Abstract

The extensor tendons of the wrist are divided into six compartments based on synovial sheaths that extend from the overlying extensor retinaculum. De Quervain’s syndrome is a frequent cause of radial-sided wrist pain that emanates from a narrowing of the first dorsal compartment due to synovial inflammation. The syndrome is common in middle-age women and overuse injuries. Patients complain of wrist pain that worsens with grasping or twisting motions. On physical examination, patients have tenderness to palpation over the APL and EPB tendons at the radial styloid. Furthermore, provocative tests reproduce the patient’s symptoms. Radiographs can help eliminate other causes of radial-sided wrist pain; however, the diagnosis of De Quervain’s syndrome is clinical. First-line treatment is nonoperative management with rest, thumb spica splinting, NSAIDs, and corticosteroid injections. Nonoperative treatment is successful in up to 80% of patients. If conservative measures fail to relieve the symptoms, then operative management can be pursued. The operation involves releasing the extensor retinaculum that forms the roof of the first dorsal compartment and any surrounding septa.