DE QUERVAIN DISEASE
De Quervain disease is a stenosing tenosynovitis of the abductor pollicis longus and the extensor pollicis brevis tendons at the styloid process of the radius. It is most common in women between 30 and 50 years of age. The cause remains uncertain but may be related to friction between the tendons, their fibrous sheath, and the underlying bony groove caused by movement of the thumb and wrist. The resulting inflammation causes thickening and stenosis of the synovial sheath of the first compartment of the extensor retinaculum (dorsal carpal ligament).
Pain develops over the styloid process of the radius, radiating up the forearm and down the thumb. Occasionally, the pain occurs suddenly after a strain of the wrist. The aching pain, aggravated by use of the hand, gradually intensifies and may sometimes cause considerable weakness and disability.
Examination shows a sharp tenderness over the styloid process of the radius, and a visible swelling and palpable thickening of the fibrous sheath may be detected. Sharp pain at this site is often produced by active extension and abduction of the thumb against resistance. The Finkelstein test usually causes severe pain.
Often, symptoms are relieved by injecting a corticosteroid into the sheath or placing the forearm, wrist, and thumb in a cast or removable splint for about 1 month, or both. If the pain recurs and persists after this treatment, surgery is indicated. With the use of local anesthesia, a short transverse incision is made over the sheath on the lateral aspect of the wrist; care must be taken to avoid the sensory branches of the superficial branch of the radial nerve. The thickened sheath is opened with a longitudinal incision through the first compartment, freeing the involved tendons. Great care must be exercised to locate and free all the tendons in the compartment because aberrant tendons and anatomic variations in the tendons and sheaths are common in this area. The incision is then closed. Prognosis is excellent.