De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal extensor compartment of the wrist, which holds abductor pollicis longus (APL) and extensor pollicis brevis (EPB).
It causes radial-sided wrist pain aggravated by thumb and wrist movement. It is most common in women aged 30 to 50, particularly mothers of young babies, and in work or hobbies with repetitive thumb use.
It is a clinical diagnosis, and most cases settle with conservative care and, if needed, corticosteroid injection.
The first dorsal compartment lies over the radial styloid, roofed by the extensor retinaculum. APL usually has several tendon slips and EPB a single slip.
A septum may divide the compartment into separate APL and EPB sub-compartments. In a systematic review it was present in 62% of surgically treated patients against 44% of cadavers. A septum is a recognised reason for injection failure, because the injection may reach only one sub-compartment.
The pathology is degenerative rather than inflammatory: myxoid degeneration of the sheath and thickening of the retinaculum narrow the compartment, so the tendons cannot glide freely.
Risk factors:
Intersection syndrome is the main differential.
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