What Is De Quervain's?
De Quervain's tenosynovitis is inflammation of the tendons on the thumb side of the wrist — the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons — which run through a tight fibrous tunnel. When this sheath becomes inflamed, movement of the thumb and wrist becomes painful. It is strongly associated with repetitive pinching, pregnancy, and new parents lifting infants.
Symptoms
- Pain and tenderness on the thumb side of the wrist
- Swelling over the radial styloid
- Pain worsening with thumb and wrist motion
- Positive Finkelstein test
Treatment
Conservative
Thumb spica splint, corticosteroid injection (highly effective — resolves most cases), NSAIDs, and activity modification.
Surgical Release
When conservative treatment fails, surgical release of the first dorsal compartment is reliable and lasting. An important detail: a significant percentage of patients have a separate subcompartment for the EPB tendon that must be identified and released — failure to do so is a common cause of persistent symptoms. Dr. Richards is attentive to this nuance.