De Quervain's tenosynovitis

De Quervain's tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30 - 50 years old.

Features

• pain on the radial side of the wrist
• tenderness over the radial styloid process
• abduction of the thumb against resistance is painful
• Finkelstein's test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

https://www.youtube.com/watch?v=8WBVXBx34W0&t=152s

Management

• analgesia
• steroid injection
• immobilisation with a thumb splint (spica) may be effective
• surgical treatment is sometimes required

DDx:

Intersection syndrome is an overuse injury that affects the tendons of the first and second dorsal compartments as they cross each other, resulting in inflammation. The pain is typically proximal to the wrist, around 4–6 cm above the wrist joint, and located on the dorsal radial side of the forearm. Patients often report a crepitus or grinding sensation in this area during wrist extension or flexion. Intersection syndrome is most commonly seen in activities involving repetitive wrist extensions, such as rowing or weightlifting. Although both conditions involve pain on the radial side of the wrist, intersection syndrome is located more proximally than De Quervain’s tenosynovitis. Treatment includes rest, splinting, NSAIDs, and occasionally steroid injections.

Radial nerve entrapment (Wartenberg’s syndrome) results from compression of the superficial branch of the radial nerve, causing numbness, tingling, and pain over the dorsal radial aspect of the wrist and hand. Unlike De Quervain’s tenosynovitis, this condition is primarily characterised by sensory symptoms (e.g., tingling and burning) rather than pain on movement or gripping. Compression often occurs due to external pressure (e.g., wearing tight wristbands or handcuffs) or direct trauma to the wrist.

Radial tunnel syndrome occurs when the posterior interosseous nerve, a branch of the radial nerve, is compressed within the radial tunnel near the elbow. This condition typically presents with deep, aching pain along the proximal forearm that worsens with wrist and finger extension. Unlike De Quervain’s, radial tunnel syndrome does not involve pain over the radial styloid or specific pain with gripping. Patients may experience weakness in wrist extension but no sensory disturbances, as the posterior interosseous nerve is primarily a motor nerve.