Physical Medicine and Rehabilitation for De Quervain Tenosynovitis

Physical Medicine and Rehabilitation for De Quervain Tenosynovitis

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De Quervain’s tenosynovitis (or de Quervain tenosynovitis) is caused by stenosing tenosynovitis of the first dorsal compartment of the wrist. The first dorsal compartment at the wrist includes the tendons of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). Patients with this condition usually report pain at the dorsolateral aspect of the wrist, with referral of pain toward the thumb and/or the lateral forearm. This condition responds well to nonsurgical treatment. [1, 2, 3, 4, 5, 6] See the images below.

In the first dorsal compartment of the wrist, a tendon sheath encloses the abductor pollicis longus and the extensor pollicis brevis tendons at the lateral border of the anatomical snuffbox. Inflammation at this site commonly is seen in patients who use their hands and thumbs in a repetitive fashion. Thus, de Quervain tenosynovitis can result from cumulative (repetitive) microtrauma. Inflammation also may occur after an isolated episode of acute trauma to the site. [6]

The first dorsal compartment of the wrist often contains a septum, which can complicate treatment by making target structures more difficult to inject. Up to 50% of patients may have first dorsal compartments with septa. These septa have an average length of 5 mm. [7]

United States

De Quervain tenosynovitis is relatively prevalent, especially among individuals who perform repetitive activities using their hands (eg, certain assembly line workers, secretaries). [8]

Mortality is not associated with de Quervain tenosynovitis. Some morbidity may result as the patient experiences progressive pain, with limitations occurring in activities requiring use of the affected hand.

Traditionally, no race predilection has been reported for de Quervain tenosynovitis. However, recently the University of Colorado School of Medicine has described the black race as a risk factor for de Quervain tenosynovitis. [8]

Although this condition is commonly seen in females and males, the incidence of de Quervain tenosynovitis appears to be significantly greater in women. [6] Some sources even quote a female-to-male ratio as high as 8:1. Interestingly, many women suffer from de Quervain tenosynovitis during pregnancy or the postpartum period. [9]

De Quervain tenosynovitis is much more common in adults than in children.

Genomic research has revealed that rs35360670 on chromosome 8 has a significant association with de Quervain tenosynovitis. [10]

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Gao ZY, Tao H, Xu H, Xue JQ, Ou-Yang Y, Wu JX. A novel classification of the anatomical variations of the first extensor compartment. Medicine (Baltimore). 2017 Sep. 96 (35):e7875. [Medline]. [Full Text].

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Kim SK, Ahmed MA, Avins AL, Ioannidis JPA. A Genetic Marker Associated with De Quervain’s Tenosynovitis. Int J Sports Med. 2017 Nov. 38 (12):942-8. [Medline].

Forget N, Piotte F, Arsenault J, et al. Bilateral thumb’s active range of motion and strength in de Quervain’s disease: comparison with a normal sample. J Hand Ther. 2008 Jul-Sep. 21(3):276-84; quiz 285. [Medline].

Goubau JF, Goubau L, Van Tongel A, Van Hoonacker P, Kerckhove D, Berghs B. The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test. J Hand Surg Eur Vol. 2014 Mar. 39(3):286-92. [Medline].

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Batteson R, Hammond A, Burke F, et al. The de Quervain’s screening tool: validity and reliability of a measure to support clinical diagnosis and management. Musculoskeletal Care. 2008 Sep. 6(3):168-80. [Medline].

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Kwon BC, Choi SJ, Koh SH, Shin DJ, Baek GH. Sonographic Identification of the intracompartmental septum in de Quervain’s disease. Clin Orthop Relat Res. 2010 Aug. 468(8):2129-34. [Medline].

McDermott JD, Ilyas AM, Nazarian LN, Keinberry CF. Ultrasound-guided injections for de Quervain’s tenosynovitis. Clin Orthop Relat Res. Jul 2012. 470(7):1925-31. [Medline].

Diop AN, Ba-Diop S, Sane JC, et al. [Role of US in the management of de Quervain’s tenosynovitis: review of 22 cases]. J Radiol. 2008 Sep. 89(9 Pt 1):1081-4. [Medline].

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Garçon JJ, Charruau B, Marteau E, Laulan J, Bacle G. Results of surgical treatment of De Quervain’s tenosynovitis: 80 cases with a mean follow-up of 9.5 years. Orthop Traumatol Surg Res. 2018 Jun 14. [Medline].

Scheller A, Schuh R, Honle W, et al. Long-term results of surgical release of de Quervain’s stenosing tenosynovitis. Int Orthop. 2009 Oct. 33(5):1301-3. [Medline].

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Lapegue F, Andre A, Pasquier Bernachot E, et al. US-guided percutaneous release of the first extensor tendon compartment using a 21-gauge needle in de Quervain’s disease: a prospective study of 35 cases. Eur Radiol. 2018 Apr 4. [Medline].

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Patrick M Foye, MD Director of Coccyx Pain Center, Professor of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Todd P Stitik, MD Professor, Department of Physical Medicine and Rehabilitation, Director, Outpatient Occupational/Musculoskeletal Medicine, Rutgers New Jersey Medical School

Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Ossur, Fidia.

Gerard J D’Onofrio, MBA Rutgers New Jersey Medical School

Gerard J D’Onofrio, MBA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association for Physician Leadership, American College of Physicians, American Medical Association, Beta Gamma Sigma, Biomedical Entrepreneurship Network

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association for Physician Leadership, American Medical Association, Academy of Spinal Cord Injury Professionals

Disclosure: Nothing to disclose.

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Robert L Sheridan, MD Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School

Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American College of Surgeons

Disclosure: Received research grant from: Shriners Hospitals for Children; Physical Sciences Inc, Mediwound.

Debra Ibrahim New York College of Osteopathic Medicine

Disclosure: Nothing to disclose.

Evish Kamrava St George’s University School of Medicine

Disclosure: Nothing to disclose.

Cyrus Kao St George’s University School of Medicine

Disclosure: Nothing to disclose.

Jason Lee St George’s University School of Medicine

Disclosure: Nothing to disclose.

Elyon Obamedo Rutgers New Jersey Medical School

Disclosures: Nothing to disclose

Varun Patibanda, MD Research Associate, Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.

Dev Sinha, MD American University of Antigua School of Medicine and Health Sciences

Disclosure: Nothing to disclose.

Physical Medicine and Rehabilitation for De Quervain Tenosynovitis

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