De Quervain Tenosynovitis
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- 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 irritation of the surrounding tendon sheath
- 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.
- 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 and thickening of the tendons (EPB, APL) and 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.
- 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, or 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
Avoid overuse or repetitive movements of the wrist and/or thumb associated with forceful grasping and ulnar/radial deviation.