De Quervain Tenosynovitis

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Basics

Description

  • First identified in 1895 by Fritz De Quervain, de Quervain tenosynovitis is a painful condition due to stenosis of the tendon sheath in the 1st dorsal compartment of the radial aspect of the wrist.
  • Caused by repetitive motion of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) over the radial styloid with resultant metaplastic changes of the surrounding tendon sheath

Epidemiology

  • The predominant age range is 30 to 50 years.
  • Women are affected more commonly than men (1).
  • With new occupational and professional demands, the prevalence of this condition is increasing gradually.

Incidence
  • The overall incidence of de Quervain tenosynovitis is 0.9/1,000 person-years.
  • For patients age >40 years, the incidence is 1.4/1,000 person-years compared with 0.6/1,000 person-years for those <20 years.
  • Women have an incidence rate ratio of 2.8/1,000 person-years compared with 0.6/1,000 person-years in men.
  • The incidence ratio rate of de Quervain tenosynovitis is 1.3/1,000 person-years in blacks and 0.8/1,000 person-years in whites (1).

Etiology and Pathophysiology

  • Repetitive motions of the wrist and/or thumb result in microtrauma, metaplastic thickening of the tendons (EPB, APL), and narrowing of the surrounding tendon sheath.
  • EPB and APL movement is resisted as they glide over the radial styloid causing pain with movements of the thumb and wrist.
  • Among individual undergoing release of the 1st dorsal compartment, histopathology of the tendon sheaths was characterized by myxoid degeneration with dense fibrous tissue and mucopolysaccharide accumulation.
  • Cadaveric analyses have identified an additional septum within the 1st dorsal compartment in 34–44% of individuals and subcompartmentalization has been reported in 86–94% of patients with de Quervain tenosynovitis (2).

Risk Factors

  • Women age 30 to 50 years
  • Pregnancy (primarily 3rd trimester and postpartum)
  • African American
  • Systemic diseases (e.g., rheumatoid arthritis)
  • Participation in activities that include repetitive motion or forceful grasping with thumb and wrist deviation such as golf, fly fishing, racquet sports, rowing, bicycling, video gaming, and more recently text messaging
  • Repetitive movements with the hand/thumb requiring forceful grasping with wrist involving ulnar/radial deviation; dental hygienists, musicians, carpenters, assembly workers, and machine operators
  • Recent analyses suggest that anatomic variability including tendon insertion variation and subcompartmentalization of the 1st dorsal compartment may be the greatest risk factors.

General Prevention

Avoid overuse or repetitive movements of the wrist and/or thumb associated with forceful grasping and ulnar/radial deviation.

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Basics

Description

  • First identified in 1895 by Fritz De Quervain, de Quervain tenosynovitis is a painful condition due to stenosis of the tendon sheath in the 1st dorsal compartment of the radial aspect of the wrist.
  • Caused by repetitive motion of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) over the radial styloid with resultant metaplastic changes of the surrounding tendon sheath

Epidemiology

  • The predominant age range is 30 to 50 years.
  • Women are affected more commonly than men (1).
  • With new occupational and professional demands, the prevalence of this condition is increasing gradually.

Incidence
  • The overall incidence of de Quervain tenosynovitis is 0.9/1,000 person-years.
  • For patients age >40 years, the incidence is 1.4/1,000 person-years compared with 0.6/1,000 person-years for those <20 years.
  • Women have an incidence rate ratio of 2.8/1,000 person-years compared with 0.6/1,000 person-years in men.
  • The incidence ratio rate of de Quervain tenosynovitis is 1.3/1,000 person-years in blacks and 0.8/1,000 person-years in whites (1).

Etiology and Pathophysiology

  • Repetitive motions of the wrist and/or thumb result in microtrauma, metaplastic thickening of the tendons (EPB, APL), and narrowing of the surrounding tendon sheath.
  • EPB and APL movement is resisted as they glide over the radial styloid causing pain with movements of the thumb and wrist.
  • Among individual undergoing release of the 1st dorsal compartment, histopathology of the tendon sheaths was characterized by myxoid degeneration with dense fibrous tissue and mucopolysaccharide accumulation.
  • Cadaveric analyses have identified an additional septum within the 1st dorsal compartment in 34–44% of individuals and subcompartmentalization has been reported in 86–94% of patients with de Quervain tenosynovitis (2).

Risk Factors

  • Women age 30 to 50 years
  • Pregnancy (primarily 3rd trimester and postpartum)
  • African American
  • Systemic diseases (e.g., rheumatoid arthritis)
  • Participation in activities that include repetitive motion or forceful grasping with thumb and wrist deviation such as golf, fly fishing, racquet sports, rowing, bicycling, video gaming, and more recently text messaging
  • Repetitive movements with the hand/thumb requiring forceful grasping with wrist involving ulnar/radial deviation; dental hygienists, musicians, carpenters, assembly workers, and machine operators
  • Recent analyses suggest that anatomic variability including tendon insertion variation and subcompartmentalization of the 1st dorsal compartment may be the greatest risk factors.

General Prevention

Avoid overuse or repetitive movements of the wrist and/or thumb associated with forceful grasping and ulnar/radial deviation.

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