De Quervain’s tenosynovitis (or syndrome) is the inflammation of the sheath, or synovium, that surrounds the tendons that run between the wrist and the thumb. More specifically, these are the tendons of the first dorsal compartment including Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB).

While the exact cause is unknown, shear forces produce inflammation with resultant thickening of the extensor retinaculum of the first dorsal compartment. Such forces include thumb adduction and ulnar wrist deviation. The thickening results in narrowing of the first dorsal compartment, such that motion of the tendons through the compartment produces pain.

De Quervain’s tenosynovitis occurs more frequently in females, often during or just after pregnancy. Many aetiologies have been suggested including repetitive motion and overuse, trauma, anatomic variations, biomechanical compression, inflammatory diseases, and increased volume states. Of particular interest are the anatomic variations, the presence of which need to be recognised and addressed if surgery is indicated.

Patients with de Quervain’s tenosynovitis experience pain along the radial side of the wrist, particularly during use of the thumb or with grasping and lifting of objects. Swelling and tenderness is often found at the same site. There are many differential diagnosis for pain in this region, the consideration and exclusion of which will be determined by Dr Tolerton’s assessment.

Initial treatment of de Quervain’s tenosynovitis is non-surgical. This includes rest, splinting, nonsteroidal anti-inflammatories (NSAIDs) and corticosteroid injections. Patients should be aware of the complications related to corticosteroid injections at this site, including subcutaneous fat atrophy, hypopigmentation of the skin, weakening or rupture of the tendons, post-injection flare of symptoms and injury to sensory nerves in close proximity. Dr Tolerton recommends such injections only be performed by those experienced with the anatomy and treatment of de Quervain’s syndrome.

Surgery is indicated when appropriate non-surgical treatment fails to provide relief of symptoms. Surgical treatment involves the open release of the first dorsal compartment. A small incision is made at the side of the wrist and the underlying first dorsal compartment is released. Post-operative rehabilitation will be individualised to your clinical presentation and post-operative recovery, with some patients requiring a removable splint for several weeks to aid symptom resolution.