De Quervain’s Disease

Case 30

De Quervain’s Disease

Kevin D. Plancher

History and Clinical Presentation

A 45-year-old right hand dominant woman presents with wrist pain that is preventing her from doing activities at home. She spends a significant amount of time in her garden, and she has noticed increased wrist pain, especially when she uses her thumb. She reports that these symptoms do not improve with rest. She denies any history of trauma to her wrist and has not been diagnosed with rheumatoid arthritis.

Physical Examination

Pain and swelling are localized over the region of the radial styloid (Fig. 30–1). The pain radiates down to the thumb and a thickened fibrous sheath is palpable over the radial styloid. Maximum tenderness is noted over the radial styloid, and tenderness is also noted along the long abductor tendon and muscle. Pain is increased with extension and abduction of the thumb against resistance. A Finkelstein test is positive and produces significant pain (Fig. 30–2).

PEARLS

Initial management consists of a custom thumb spica splint and additional antiinflammatory medication and a possible corticosteroid injection
Careful attention to technique during injecting (needle angle and placement)
Longitudinal septum may divide the APL and the EPB in 20 to 30% of patients.
Necessary to identify and release both the EPB and APL before closure during surgery

PITFALLS

Unresponsiveness to corticosteroid injections and recurrent symptoms can occur because of the presence of the longitudinal septum
Injection not placed correctly will lead to recurrence of symptoms
Patient falling to follow conservative treatment regiment with hand therapy will in 5% of all patients necessitate surgical release

Diagnostic Studies

Radiographs consisting of a posteroanterior (PA) and lateral view of the wrist as well as the important hyperpronated view or Robert’s view were within normal limits. No carpometacarpal (CMC) arthritis was evident on the Robert’s view.