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DE QUERVAIN’S

TENDONITIS
Johann Fredrich (called Fritz) de
Quervain (1868-1940) was from
Switzerland. He was assistant then
successor of Kocher.

DE QUERVAIN’S TENOSYNOVITIS

▸ He described
the disease in
1895, and
immediately
makes the link
with trigger
fingers

DE QUERVAIN’S TENOSYNOVITIS

▸ 2,8/1 000 in females; 0,6 / 1000 in males
▸ Female > 40 years (except « baby’s wrist »)
▸ Mechanical factors (repetitive mouvements as described
for mobiles, in volleyeurs, endoscopists,…and with
aromatase-inhibitors)
▸ Clinical diagnosis
▸ Medical treatment

ANATOMY
▸ Osteo-fibrous tunnel on the
dorso-radial aspect of the
wrist
▸ Contains two tendons:
▸ Abductor pollicis longus
▸ Extensor pollicis brevis

- Le rétinaculum

2 tendons

ANATOMICAL VARIATIONS
▸ APL has from 2 to 9 tendinous slips
▸ Most often 2 - 4 slips in 94% of cases in a
surgical series (Minimikawa, 1991)
▸ EPB absent in 5-7% of cases

2
1

3

ANATOMICAL VARIATIONS
▸ There is a septum that divides either totally or
partially the 1st compartment in two parts

Septum

EPB

APL

FREQUENCY OF THE SEPTUM
Mean
Anatomical studies
11
29 % to 77,5%
Surgical series
10 studies

46 to 91%

46 %

67 %

▸ Contributing factor for De Quervain’s tenosynovitis
▸ Contributing factor for failures of medical treatment

DE QUERVAIN’S TENOSYNOVITIS

▸ Suffering of the APL and/or
EPB in the 1st
compartment of the
extensors under a
thickened sheath (2 mm vs
0,43 in the control group)

CLINICAL SIGNS
▸ Swelling +/- ganglion
▸ Spontaneous pain and during
pression
▸ Pain during resisted extension
▸ Pain during passive tension
(Finkelstein’s, Eischoff's, Brunelli ’s
signs, WHAT,…)
▸ Rarely:
▸ Radial apophysitis
▸ Superficial radial nerve entrapment
/Irritation (Matzdorff’s syndrome)

PROVOCATIVE MANEUVERS

▸ They place the tendon(s) under tension into the sheath
▸ One usually mistakes between Eischoff’s maneuver (1927) with those described
by (1930) [which are very close]

PROVOCATIVE MANEUVERS
Eischoff

▸ Eischoff: brutal placement under tension (ulnar
inclination) of the APL tendon

TEST OF BRUNELLI
▸ Would be are precise as tendons
will rub against the pulley, not the
radius
▸ No scientific paper to valid this
hypothesis

Brunelli G: Le test de Finkelstein contre le test de
Brunelli dans la tenosynovite de De Quervain. Chir
Main 2003;22;1:43-45

PROVOCATIVE MANEUVERS

▸ WHAT test: Wrist hyper flexion
abduction test
▸ Resisted abduction of the thumb
on a hyperflexed wrist

Goubau J et al. 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 2014 Mar;39(3):286-92

VALIDITY OF THE TESTS
▸ Wrist hyperflexion thumb abduction would me more
sensible and more specific

Sensibility

Specificity

EischoffFinkelstein

89 %

14 %

WHAT test

99 %

29 %

Goubau J et al. 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 2014 Mar;39(3):286-92

CAN WE KNOW WHICH TENDON IS MORE INVOLVED ?

▸ if pain is more intense in
resisted extension of the
thumb than in resisted
palmar abduction
▸ Should evoque EPB
suffering more than APL
▸ Sensibility 81%, specificity
50%

Alexander RD, Catalano LW, Barron OA, Glickel SZ: The extensor pollicis brevis entrapment test in the
treatment of de Quervain’s disease. J Hand Surg [Am] 2002;27:813–816.

ARE IMAGING TECHNIQUE NECESSARY ?

▸ X-rays are useless
▸ May show apophysitis, localized
oetopenia, a bone bump
▸ Without relation with clinical
signs nor results of treatment
▸ Sonography > MRI

Thickening of the retinaculum

sag view

100% of cases
asymptomatic side

Axial view

asymptomatic
side

THICKENING OF THE RETINACULUM WITH A GANGLION

HYPERVASCULARIZATION WITH DOPPLER

Thickening

Tendon

CONSTRICTION EFFECT
liquid

liquid
R

Mass effect over the tendons= > Zone of maximum constriction of
tendons
Allows (sometimes) the visualization of the septum and/or the site of
the constriction

DE QUERVAIN’S TENOSYNOVITIS: MEDICAL TREATMENT

▸ Association of:
▸ Splint
▸ Steroid Injection,
▸ NSAIDs
▸ Suppression of a provocative movement
▸ Is very efficient

RESULTS OF MEDICAL TREATMENT
Only
Only
Injection + Only
NSAIDs
injection
Splint
splint
rest
Rate of
cure

83%

61%

14%

0%

50% are recurrence
still cured before the
at 1 year 6th months
A pooled quantitative literature evaluation Richie, 2003, J Am Board Fam Pract

0 %

COMPLICATIONS OF STEROID INJECTIONS

▸ Skin suffering
▸ usually resolutive
▸ Do not multiply injections, should
be « deep »
▸ under sonographic control ?

DE QUERVAIN’S TENOSYNOVITIS: SURGICAL TREATMENT
▸ Traverse (more cosmetic)
approach / longitudinal
▸ Should see and protect the radial
neve

DE QUERVAIN’S TENOSYNOVITIS: SURGICAL TREATMENT
▸ Open the posterior
part of the 1st
compartment

DE QUERVAIN’S TENOSYNOVITIS: SURGICAL TREATMENT
▸ Release the frequent septum between
EPB and APL +++
▸ Verify that both tendons have been
release +++
▸ Traction over the EPB
▸ Traction over the APL (many slips)
▸ Control absence of anterior tendon
dislocation
▸ Synovectomy if necessary

DE QUERVAIN’S TENOSYNOVITIS: SURGICAL TREATMENT

▸ Fixation of the posterior edge of
the retinaculum to the dermis
▸ sub-cuticular running suture
▸ Relative rest during the post-op
period

DE QUERVAIN’S TENOSYNOVITIS: SURGICAL TREATMENT

Longitudinal incision in this exceptional situation

ENDOSCOPIC TREATMENT

▸ Dr Desmoineaux