My Orthopedic Surgery

In 1895, a Swiss surgeon, Fritz de Quervain, published 5 case reports of patients with tender thickened first dorsal compartments at the wrist. The condition subsequently has borne his name. The disease is an entrapment tendinitis of the tendons contained within the first dorsal compartment at the wrist, resulting in pain with thumb motion.

De Quervain disease 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 lateral forearm. This condition responds well to nonsurgical treatment.

De Quervain tenosynovitis: Definition(s) via UMLS "Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons in the first dorsal wrist compartment. The presenting symptoms are usually pain and tenderness at the radial styloid. The cause is almost always related to OVERUSE INJURY or is associated with RHEUMATOID ARTHRITIS." Source: Medical Subject Headings, 2007_2006_08_08

Madigan Army Medical Center Referral Guidelines for deQuervain's Syndrome Tendonitis/Tenosynovitis of the extensor pollicis brevis and abductor pollicis longus within the extensor sheath of the first digit.

Dequervain's tenosynovitis of the first dorsal extensor compartment is a common affliction in any hand practice.

Wheeless' Textbook of Orthopaedics a stenosing tenosynovitis of APL & EPB tendons (first compartment) at the styloid process of the radius; - inflammation causes thickening & stenosis of synovial sheath of first compartment & pain w/ tendon movement; - most common in women between 30 and 50 years; - pts develop pain over radial styloid process (& sometimes forearm & thumb);

The patient, usually a middle-aged woman, has difficulty with tasks like opening jars because of pain at the base of the thumb, which may also be present upon awakening. On examination, there is little or no swelling and no deformity, just tenderness on palpating or stretching the extensor pollicis brevis and abductor pollicis longus tendons bordering the palmar side, or less commonly, the extensor pollicis longus tendon bordering the dorsal side of the anatomic snuffbox.

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Flexor tenosynovitis (FT) is a pathophysiologic state causing disruption of normal flexor tendon function in the hand. A variety of etiologies are responsible for this process. Most acute cases of FT are the result of infection. However, FT also can be secondary to acute or chronic inflammation as a result of diabetes, overuse, or arthritis. Much of the original work on infectious FT was done by Kanavel. If a patient presents with the 4 Kanavel signs, septic FT is diagnosed. The 4 Kanavel signs are (1) finger held in slight flexion, (2) fusiform swelling, (3) tenderness along the flexor tendon sheath, and (4) pain with passive extension of the digit. The process has the ability to rapidly destroy a finger's functional capacity and is considered an orthopedic emergency.
Synonyms and related keywords: acute flexor tenosynovitis, flexor tendon sheath infection, flexor tenosynovitis, pyogenic flexor tenosynovitis, suppurative flexor tenosynovitis, septic flexor tenosynovitis
Likes & Ghidella 2004

Multiple conditions can cause radial-sided wrist and forearm pain; the most common are de Quervain tenosynovitis and thumb carpometacarpal (CMC) arthritis. Intersection syndrome (tenosynovitis of the radial wrist extensors) can also cause radial-sided wrist and forearm pain.
Intersection syndrome is tenosynovitis of the radial wrist extensors, extensor carpi radialis longus (ECRL), and extensor carpi radialis brevis (ECRB). The condition also affects the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL), causing pain and swelling of these muscle bellies. Intersection syndrome is characterized by pain and swelling in the distal dorsoradial forearm.
Intersection syndrome is much less common than de Quervain tenosynovitis, the syndrome with which it is most easily confused.
Synonyms and related keywords: tenosynovitis of the radial wrist extensors, tendinitis, de Quervain tenosynovitis, thumb carpometacarpal arthritis, thumb CMC arthritis, wrist pain, forearm pain
Author: David R Steinberg, MD 2002

Tenosynovitis involves inflammation of the tendon and tendon sheath. Examples of tenosynovitis include de Quervain tenosynovitis of the wrist (ie, abductor pollicis longus and extensor pollicis brevis tendons), volar flexor tenosynovitis (ie, trigger finger), pyogenic flexor tenosynovitis, which can be from gonococcal (GC) infections and other infectious etiologies.
Synonyms and related keywords: de Quervain tenosynovitis of the wrist, abductor pollicis longus tendons, extensor pollicis brevis tendons, volar flexor tenosynovitis, stenosing tenosynovitis, trigger finger, gonococcal tenosynovitis, GC tenosynovitis, Finkelstein test, nongonococcal infectious tenosynovitis, suppurative tenosynovitis, pyogenic flexor tenosynovitis, cardinal signs of Kanavel, Neisseria gonorrhoeae, Staphylococcus aureus, Streptococcus species, Pasteurellamultocida, cat bites, Eikenella corrodens, human bites, Mycobacterium species, diabetes mellitus, intravenous drug abuse, IV drug abuse, arteriosclerosis obliterans
Norvell & Steele 2008

One of the commonest upper limb problems to be encountered in orthopaedic practice, trigger finger or trigger digit as variously called has remained a mystery regards its formation.
In the past, triggering of the digits was treated by splinting in extension, which caused stiffness and consequently loss of metacarpophalangeal and interphalangeal flexion. Due to dissatisfaction with this form of treatment, researchers used intrasheath steroid injections, which resulted in a high proportion of good results (Marks, 1989).
Surgery in the form of release of the A1 pulley became popular when splinting and/or injection therapy failed or in the presence of other pathology such as rheumatoid arthritis in which injection treatment proved futile or risked of tendon rupture or infection.
Synonyms and related keywords: TF, trigger digit, snapping digit, locking digit, stenosing tendovaginitis, peritendinitis stenosans, digitus saltans
Author: Satishchandra Kale, MD 2006

Painful triggering or locking of the thumb is a common malady that can significantly interfere with hand function and the performance of routine activities. Much less frequently, a similar condition may occur in children. The condition in children has been referred to as congenital trigger thumb, although it usually presents sometime after infancy.
Synonyms and related keywords: trigger finger, tenosynovitis, stenosing tenosynovitis, stenosing tendovaginitis, thumb pain, locked thumb, idiopathic trigger thumb, congenital trigger thumb
Author: David R Steinberg, MD 2003