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Tenossinovite de De Quervain Folheto In-depth

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

O que você está sentindo

A tenossinovite de De Quervain causa dor no lado do polegar do seu pulso, perto da base do polegar. Essa área também pode ficar sensível ao toque e ligeiramente inchada. O problema ocorre em um túnel estreito por onde passam dois tendões do polegar; quando esse túnel fica irritado, os tendões travam durante o movimento.

Certos movimentos pioram a dor: dobrar o pulso em direção ao dedo mindinho, segurar algo com força enquanto o pulso está dobrado ou juntar o polegar e o indicador podem desencadear a dor. Você pode percebê-la ao levantar uma chaleira, girar uma maçaneta, pegar o bebê no colo ou usar tesouras. Algumas pessoas notam que a dor piora ao acordar ou após um período de atividade.

A causa exata não está claramente relacionada à profissão ou a algum ferimento específico. A condição pode aparecer junto com outros problemas no pulso, mas frequentemente se desenvolve isoladamente.

Geralmente, seu cirurgião consegue diagnosticar o problema ao examinar o pulso e identificar onde está a dor. Exames de imagem não são necessários quando o quadro clínico é evidente; eles são usados apenas para verificar outras possibilidades, como fraturas antigas ou artrose na base do polegar.

A maioria das pessoas opta inicialmente por tratamentos simples; a maior parte sente melhora dos sintomas dentro de um ano. A injeção de corticosteroide no túnel afetado é o primeiro passo usual, sendo eficaz após duas aplicações em 73,4% dos casos. O uso de talas, por si só, é menos eficaz que a injeção.

Se a dor for intensa ou impedir que você realize suas atividades diárias, pode ser discutida uma cirurgia para alargar o túnel afetado. Esse procedimento, chamado de liberação do primeiro compartimento extensor, é o tratamento padrão quando as injeções não surtem efeito suficiente.

O que está realmente acontecendo

Os dois tendões responsáveis por mover o polegar para longe da mão passam por um túnel estreito na face lateral do punho. Imagine os tendões como cordas lisas e o túnel como uma faixa de polia que os mantém próximos ao osso. Nessa condição, o túnel torna-se apertado e espessado, impedindo que os tendões deslizem livremente.

O atrito entre os tendões e as paredes do túnel provoca inchaço no interior desse espaço. Com o tempo, a bainha tendinosa sofre alterações: torna-se densa e fibrosa, adquirindo uma consistência semelhante à de um gel. Os tendões também podem desenvolver faixas adesivas que os fixam à parede do túnel. O resultado é um canal ainda mais estreito, e todo movimento do polegar faz com que os tendões inchados sejam puxados através dele. Esse puxão irrita os receptores de dor, motivo pelo qual os movimentos de pinça e de aperto mencionados anteriormente causam dor.

Em algumas pessoas, o túnel é naturalmente estreito. Cerca de um terço da população possui uma parede extra no interior do túnel, dividindo-o em dois compartimentos; além disso, algumas pessoas têm tendões adicionais que compartilham esse espaço limitado. Essas variações podem estar presentes em ambos os punhos, aumentando a probabilidade de congestionamento dos tendões.

Essa condição é frequentemente chamada de tenossinovite, termo que sugere inflamação da bainha tendinosa. Na realidade, as alterações teciduais assemelham-se mais ao desgaste e à degeneração do que a uma inflamação clássica. O inchaço e o espessamento são reais, mas resultam da degradação da bainha tendinosa sob carga, e não de uma simples reação inflamatória.

A dor não indica que o punho foi danificado por uso excessivo. Não há relação comprovada entre o uso da mão no trabalho ou alguma lesão específica e essa condição. Ela é mais comum em mulheres e pode surgir após outros problemas no punho, como fraturas tratadas cirurgicamente.

O que podemos fazer a respeito

O Dr. Kieran Hirpara, cirurgião de membros superiores no Mater Private Hospital Rockhampton, começa com as opções menos invasivas adequadas ao seu quadro clínico. Geralmente, os pacientes são encaminhados à nossa clínica pelo seu médico de família; caso um fisioterapeuta tenha sugerido que você nos procure, ainda assim será necessário um encaminhamento do seu médico de família para que você tenha direito ao reembolso do Medicare. Na sua primeira consulta, colhemos o histórico clínico, examinamos o seu punho e solicitamos exames de imagem apenas se houver necessidade de avaliar algo adicional. Como esse problema é crônico e não uma lesão recente, normalmente iniciamos com tratamento não cirúrgico.

Os primeiros passos são medidas que você mesmo pode tomar. O repouso do polegar e do punho ajuda; uma tala tipo “spica” para o polegar mantém essas regiões imóveis, permitindo que o túnel irritado tenha tempo para se recuperar. A tala pode aliviar a dor enquanto você a usa, mas deixa de ser eficaz assim que as articulações voltam a se mover livremente. A terapia ocupacional pode ser associada à injeção; essa combinação demonstrou reduzir a dor nos testes clínicos [2]. Existem também tratamentos nos quais um creme medicado é introduzido na pele por meio de uma pequena corrente elétrica, ou nos quais ondas sonoras são aplicadas na área dolorida; esses métodos podem melhorar a função do punho e atenuar a dor.

O principal tratamento médico consiste na injeção de cortisona no túnel. A cortisona é um potente anti-inflamatório que reduz o inchaço ao redor dos tendões. Uma única injeção aliviou os sintomas em 82% dos pacientes, e mais da metade desses permaneceu sem sintomas por pelo menos 12 meses. Caso você seja diabético, uma única injeção tem menor probabilidade de surtir efeito; porém, injeções repetidas não perdem sua eficácia. A associação da injeção com o uso de tala é mais eficaz do que a injeção isoladamente. Outras injeções, como as à base de ácido hialurônico ou PRP, não fazem parte do tratamento que oferecemos para essa condição.

Se o tratamento não cirúrgico não proporcionar alívio suficiente, conversaremos sobre a cirurgia. A operação visa aliviar a pressão no túnel, permitindo que os tendões deslizem livremente; ela é indicada quando as injeções e o uso de talas não controlam os sintomas. Antes de tomar qualquer decisão, explicaremos detalhadamente o procedimento, o processo de recuperação e os resultados esperados, em conjunto com você.

O que esperar

Na maioria das pessoas, essa condição melhora com o tempo. A maior parte dos pacientes percebe que os sintomas desaparecem em até um ano. Muitas pessoas conseguem se virar bem sem cirurgia: apenas cerca de um terço dos pacientes com essa condição acabam precisando de uma operação dentro de dois anos; quando a cirurgia é necessária, geralmente ocorre no primeiro ano.

O tratamento visa encurtar esse período de recuperação. A injeção de cortisona, associada a um breve período de imobilização com tala, é o principal método de tratamento inicial e funciona para a maioria das pessoas. Se a primeira injeção ajudar, mas a dor retornar, uma segunda injeção ainda é uma opção razoável. A taxa de sucesso diminui com injeções repetidas, mas elas continuam sendo uma ferramenta útil.

Se você tem diabetes, uma única injeção tem menos probabilidade de aliviar seus sintomas em comparação a outras pessoas. A boa notícia é que injeções subsequentes não perdem sua eficácia em diabéticos; portanto, repetir o tratamento ainda vale a pena.

A cirurgia é indicada apenas para o pequeno grupo cuja dor não melhora com injeções e imobilização. Nesses casos, a liberação do túnel comprimido traz alívio duradouro para os tendões, e a operação apresenta baixo índice de complicações.

A forma como você encara a condição também faz diferença. Pessoas que esperam o pior tendem a relatar mais dor e menor funcionalidade; portanto, ter uma visão clara do que está por vir ajuda a escolher o tratamento mais adequado ao seu estilo de vida. A preocupação de ter danificado o punho por uso excessivo não é corroborada por evidências; saber disso pode diminuir o medo durante os episódios de dor.

Não existe um cronograma garantido para todos. Alguns punhos respondem rapidamente à injeção; outros precisam de uma dose repetida; e alguns acabam necessitando de cirurgia. Quando a condição é bem tratada, a dor geralmente diminui e os tendões voltam a deslizar livremente. Mesmo sem intervenção, a maioria dos casos melhora dentro de um ano; porém, nesse intervalo, você pode passar meses lidando com o desconforto.

Quando procurar ajuda médica

Consulte o seu médico de família se a dor no lado do polegar do seu pulso persistir ou se ela impedir que você realize suas atividades habituais, mesmo após repouso e uso de talas. Solicite uma avaliação por um especialista caso as injeções não tenham aliviado os sintomas, ou se a dor for intensa a ponto de limitar o uso da mão no dia a dia. Em alguns casos, os sintomas melhoram espontaneamente dentro de um ano; porém, aguardar não é a única opção, e o tratamento pode acelerar esse processo. Caso perceba formigamento, dormência ou sensações incomuns no polegar ou no pulso, que não correspondam ao padrão habitual, mencione isso na consulta, pois outros problemas no pulso podem, às vezes, mimetizar esta condição.

Em maior profundidade

Advanced reading: the deeper science (optional)

Esta seção aborda tópicos além do necessário para a tomada de decisões terapêuticas por parte do paciente. A tenossinovite de De Quervain merece essa leitura adicional devido a uma pequena variante anatômica que explica grande parte da insatisfação pós-operatória, mesmo em casos em que o procedimento cirúrgico é, em geral, eficaz. Além disso, o melhor resultado sem intervenção cirúrgica é obtido pela combinação de dois tratamentos, em vez da escolha de apenas um deles.

A combinação dos tratamentos supera cada um deles isoladamente

O primeiro compartimento dorsal abriga dois tendões num túnel localizado no lado do polegar do punho. O objetivo do tratamento é controlar a inflamação nesse túnel e reduzir a carga que nele atua.

Uma metanálise de rede envolvendo 823 pacientes concluiu que a injeção de corticosteroide associada a um breve período de imobilização continua sendo o tratamento primário e eficaz, sendo a terapia por ondas de choque extracorpóreas uma opção secundária [1]. Ao analisar separadamente cada intervenção, as abordagens que combinam órtese e injeção de corticosteroide são mais eficazes do que qualquer uma delas isoladamente [2].

Essa orientação é mais específica do que o conselho genérico “use uma tala e, se não funcionar, aplique uma injeção”. As evidências científicas respaldam a aplicação conjunta dessas medidas, com a tala sendo utilizada por um curto período após a injeção.

Uma segunda injeção ainda vale a pena

Quando os sintomas retornam, o reflexo natural é concluir que as injeções falharam e optar pela cirurgia. No entanto, os dados obtidos de um grande grupo de pacientes indicam o contrário: embora a taxa de sucesso diminua com múltiplas injeções, as injeções repetidas apresentam alta taxa de sucesso e constituem uma opção clínica viável [3].

É esperado que a eficácia das injeções diminua com a repetição. Contudo, uma taxa de sucesso menor não equivale a ineficácia; portanto, a segunda injeção continua sendo uma medida razoável, e não apenas uma tática para adiar o tratamento cirúrgico.

A variante que explica a maioria das decepções cirúrgicas

A liberação do primeiro compartimento dorsal é eficaz; porém, quando ocorrem insucessos, geralmente há um motivo específico. A insatisfação do paciente pode advir de liberação incompleta, subluxação tendínea, lesão nervosa ou simplesmente do tempo de recuperação. Além disso, a existência de uma bainha do extensor pollicis brevis não identificada e não liberada é uma causa concreta de insatisfação [4].

Esse ponto merece destaque, pois é o fato mais relevante desta seção. Em uma proporção considerável de pacientes, o compartimento não é um único túnel, mas dois: o tendão do extensor pollicis brevis corre em sua própria bainha, separada das demais. Uma liberação que abre apenas o compartimento principal deixa essa segunda bainha intacta, mantendo o tendão comprimido. O punho é aberto, a cirurgia é concluída conforme descrito, mas os sintomas persistem.

É também por esse motivo que as outras duas causas listadas são importantes: uma liberação excessiva permite que os tendões se subluxem para fora do sulco durante os movimentos do punho, gerando um estalo doloroso; além disso, o ramo superficial do nervo radial cruza exatamente sobre a área operatória. O compartimento deve ser aberto por completo, porém sem exageros, especialmente com um nervo no caminho – razão pela qual uma cirurgia aparentemente simples exige o mesmo cuidado que uma operação mais complexa.

Nem todoa dor no punho radial se deve à síndrome de De Quervain

A dor nessa região apresenta diversas possíveis causas que vale a pena conhecer, pois os tratamentos são distintos: artrite na base do polegar, síndrome da intersecção a poucos centímetros mais acima no antebraço e irritação do nervo radial podem todas provocar dor na mesma área. A sensibilidade localizada exatamente sobre o compartimento em questão, com dor que se reproduz ao realizar desvio ulnar do punho com o polegar dobrado na palma da mão, é o que indica que o problema está na bainha tendinosa e não em estruturas vizinhas.

Referências

[1] Chong HH, Pradhan A, Dhingra M, Liong W, Hau MY, Shah R. Avanços no tratamento da tenossinovite de De Quervain: uma meta-análise de rede abrangente de ensaios clínicos randomizados. J Hand Surg Am. 2024;49(6):557-69. https://doi.org/10.1016/j.jhsa.2024.03.003

[2] Cavaleri R, Schabrun SM, Te M, Chipchase LS. Terapia ocupacional versus injeções de corticosteroides no tratamento da doença de De Quervain: uma revisão sistemática e meta-análise. J Hand Ther. 2016;29(1):3-11. https://doi.org/10.1016/j.jht.2015.10.004

[3] Hassan K, Sohn A, Shi L, Lee M, Wolf JM. Tenossinovite de De Quervain: avaliação da epidemiologia e da utilidade de múltiplas injeções com base em um banco de dados nacional. J Hand Surg Am. 2022;47(3):284.e1-284.e6. https://doi.org/10.1016/j.jhsa.2021.04.018

[4] Rogozinski B, Lourie GM. Insatisfação após liberação do compartimento dorsal para tratamento da tendinopatia de De Quervain. J Hand Surg Am. 2016;41(1):117-9. https://doi.org/10.1016/j.jhsa.2015.09.003

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Anatomy

  • Anatomical variations in the first extensor compartment are clinically relevant to the pathophysiology and treatment of De Quervain's tenosynovitis [1].

Non-Operative Management

  • Corticosteroid injection is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis [2].
  • Corticosteroid injection with a short duration of immobilization is the primary and effective treatment for de Quervain tenosynovitis [14].
  • The success rate for treating De Quervain's tenosynovitis decreases with multiple injections [25].
  • Repeat injections for De Quervain's tenosynovitis have a high rate of success and are a viable clinical option [25].
  • Patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [8].

Operative Management

  • Surgical release of De Quervain's tenosynovitis remains the gold standard treatment [6].
  • Longitudinal incision for surgical release offers the advantage of easy identification of the compartment [6].
  • Longitudinal incision for surgical release offers the advantage of more complete releases of tendon sheath and peritendinous adhesions [6].
  • Longitudinal incision for surgical release offers the advantage of less risk of palmar subluxation of tendons [6].
  • Release of the first extensor compartment for refractory de Quervain's disease results in good clinical outcomes with minimal morbidity [12].
  • Endoscopic release of the extensor compartment is an effective and safe procedure for patients with de Quervain's disease who are unresponsive to nonoperative treatments [28].
  • Endoscopic release of the extensor compartment is associated with a slight increase in operation time compared to open release [28].
  • Endoscopic release for de Quervain's tenosynovitis provides earlier improvement after surgery compared with open release [30].
  • Endoscopic release for de Quervain's tenosynovitis is associated with fewer superficial radial nerve complications compared with open release [30].
  • Endoscopic release for de Quervain's tenosynovitis is associated with greater scar satisfaction compared with open release [30].
  • Pulley reconstruction should be considered part of the surgical treatment for de Quervain tenosynovitis [4].
  • Pulley reconstruction for de Quervain tenosynovitis provides satisfactory medium-term results [4].

Patient Factors and Outcomes

  • Patients who scored lower than 40 for physical function had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis [23].
  • Patients who scored higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis [23].
  • Addressing misconceptions about the consequences of de Quervain's tenosynovitis and symptom duration allows patients to make informed decisions about treatment [5].

Anatomy & Pathophysiology

Anatomical Variations

  • The EPB tendon is the most dorsal tendon in the first dorsal compartment and can be identified by its distally oriented muscle fibers [15].
  • The APL tendon has no muscular fibers in the area of the first dorsal compartment [15].
  • Separate compartments for the EPB and APL tendons are occasionally found, requiring identification of a septum [15].
  • If the EPB tendon is absent, the floor of the compartment may show a Y-shaped tendinous insertion of the brachioradialis tendon [15].
  • The superficial branch of the radial nerve is expected to be encountered in more than 50% of patients undergoing surgery for De Quervain's tenosynovitis [58].
  • The radial artery courses dorsally just beyond the radial styloid, requiring caution during septum resection [15].

Pathological Mechanisms

  • De Quervain's syndrome is defined as inflammation of the APL and EPB tendons in the first dorsal compartment caused by friction within a tight osteoligamentous tunnel [3].
  • Friction between the APL and EPB tendons leads to compromised blood flow and nutrition, resulting in adhesion development and tendon stenosis [3].
  • De Quervain's syndrome may involve myxoid degeneration, a process where connective tissues are replaced by a gelatinous or mucoid substance [3].
  • De Quervain's syndrome is associated with trauma, extensor carpi ulnaris involvement, ligament instability, and repetitive strain [3].
  • Tenovaginitis in the first extensor compartment is characterized by thickening of the fibrous sheath [11].
  • De Quervain's disease results from anatomical factors associated with mechanical stressors [43].
  • Women are more affected by De Quervain's disease than men due to manual work influencing first compartment dynamics [43].
  • Training intensity is a major factor in determining De Quervain's disease in volleyball players [43].
  • Wrist position influences the excursion of the extensor pollicis brevis tendon [44].
  • Stenosing tenosynovitis causes a significant decrease in maximum velocity during slow fist tasks [48].

Classification

Anatomical Variations and Pathophysiology

  • De Quervain's syndrome is defined as a condition originating when the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment become inflamed through friction within a tight osteoligamentous tunnel [3].
  • The condition is characterized by compromised blood flow and nutrition, leading to adhesions and tendon stenosis [3].
  • De Quervain's syndrome may represent a myxoid degeneration, defined as a degenerative process where connective tissues are replaced by a gelatinous or mucoid substance [3].
  • Terminology for the condition varies, including tendinosis (degeneration without inflammation), tendinopathy (injury to the tendon), and tenosynovitis (inflammation or thickening of the fibrous sheath wall) [3].
  • De Quervain's syndrome may not be an isolated pathology and has been associated with trauma, extensor carpi ulnaris involvement, ligament instability, and repetitive strain [3].
  • The prevalence of a septated first dorsal compartment is considerably higher in patients with De Quervain tenosynovitis than previously reported [42].
  • An intracompartmental septum between the APL and EPB tendons is present in a mean of 43% of wrists in cadaveric studies, with a range of 20% to 75% [17].
  • The presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection [17].
  • In a prospective study, 22 of 30 wrists (73%) that failed nonsurgical treatment and underwent operative release were found to have a separate compartment for the extensor pollicis brevis [32].
  • The prevalence of a separate extensor pollicis brevis compartment in patients failing nonsurgical treatment is significantly higher than in the general population [32].
  • In cases where constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised [18].
  • Radial styloid abnormalities do not affect the outcome of management for de Quervain's disease [10].

Epidemiology and Risk Factors

  • The unadjusted incidence rate of de Quervain's tenosynovitis in a young, active population was 0.94 per 1000 person-years [31].
  • The unadjusted incidence rate for female patients was 2.81 per 1000 person-years, compared with 0.62 per 1000 person-years for male patients [31].
  • The adjusted incidence rate ratio for females, with males as the referent category, was 4.45 (95% CI 4.28, 4.62) [31].
  • The highest incidence rate was observed in the ≥40-year-old group at 1.37 per 1000 person-years [31].
  • The adjusted incidence rate ratio for the ≥40-year-old group, compared to the <20-year-old group, was 3.65 (95% CI 3.26, 4.09) [31].
  • Non-white race is a risk factor for de Quervain's tenosynovitis, with an adjusted incidence rate ratio of 1.31 (95% CI 1.21, 1.42) for black race and 1.17 (95% CI 1.05, 1.25) for other races compared to white race [31].
  • De Quervain's syndrome affects approximately 1.3% of women and 0.5% of men in a population of adults of working age [17].

Diagnostic and Clinical Considerations

  • Routine wrist radiography prior to surgeon evaluation is wasteful as patients do not benefit from the resulting radiologic data [7].
  • Addressing misconceptions about the consequences of de Quervain's tenosynovitis and symptom duration allows patients to make informed treatment decisions [5].
  • Patients with a physical function score lower than 40 or a pain interference score higher than 60 on PROMIS measures had significantly increased odds of undergoing surgical release [23].

Clinical Presentation

Anatomy and Pathophysiology

  • De Quervain's syndrome is defined as a condition where the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment become inflamed through friction, leading to pain [3].
  • In De Quervain's syndrome, blood flow and nutrition become compromised, causing adhesions that lead to tendon stenosis [3].
  • The condition is referred to by various terminologies including tendinosis, tendinopathy, and tenovaginitis/tenosynovitis [3].
  • Fritz de Quervain described pain over the first dorsal compartment as a tenosynovitis following repetitive activity in 1895 [3].
  • Theodor Kocher described de Quervain's as a "fibrous tendovaginitis" around the same time, noting that his patients lacked a history of repetitive strain [3].
  • The pain in de Quervain's disease is attributed to friction of the EPL and APB against the pulley of zone 7 of the first extensor compartment [35].
  • This friction results in initial tendinopathy followed by reactive thickening of the pulley [35].
  • A septum can be present between the EPB and APL tendons within the first dorsal compartment [35].
  • The EPB tendon is very small in bulk, while the APL has a variable number of tendons in its final portion at insertion [35].
  • De Quervain's syndrome may not be an isolated pathology and may be associated with trauma, extensor carpi ulnaris involvement, ligament instability, or repetitive strain [3].

Clinical Symptoms and Signs

  • Patients with de Quervain's tenosynovitis mostly complain of soreness and tenderness on the radial side of the distal radius [35].
  • Symptoms are exacerbated by ulnar deviation of the thumb [35].
  • Symptoms are exacerbated by a strong grasp combined with flexion and radial deviation of the wrist [35].
  • Symptoms are exacerbated by firm pinching together of the index finger and thumb [35].
  • Physical examination reveals tenderness and swelling directly over the first dorsal compartment [35].
  • Palpation findings include feeling for moving nodularity, tendon rub, or popping directly over the tendon [38].

Diagnostic Testing

  • Finkelstein's test is described as the standard test to confirm the diagnosis of de Quervain's tenovaginitis [35].
  • The WHAT test (wrist hyperflexion and abduction of the thumb) is a more specific and sensitive test to diagnose de Quervain tenosynovitis than Eichhoff’s Test [35].
  • Finkelstein's test is superior to Eichhoff's test in the investigation of de Quervain's disease [38].
  • The clinical diagnosis of de Quervain's tenosynovitis involves pain and tenderness over the radial styloid and either pain at the radial styloid reproduced by resisted thumb extension or a positive Finkelstein's test result [26].
  • Using the asymptomatic thumb as a standard measure to identify the symptomatic thumb's impairments associated with de Quervain's disease may be invalid [39].

Imaging

  • Plain radiographic findings do not routinely predict the need for surgery or alter treatment courses in the initial diagnosis of De Quervain's tenosynovitis [37].
  • In a study of 200 patients, 69.1% had at least one positive radiographic finding, with carpometacartic joint arthritis being the most common finding seen in 30.9% of cases [37].
  • No radiographic findings altered the course of treatment in patients with isolated De Quervain's tenosynovitis [37].

Patient Factors and Perception

  • More negative perceptions of the consequences of de Quervain's tenosynovitis are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression [21].
  • Worse pain catastrophizing is associated with worse pain and reduced function at baseline in patients awaiting surgical decompression of de Quervain's tenosynovitis [21].

Investigations

Imaging

  • Ultrasound is a useful imaging technique for diagnosing de Quervain's disease and provides important information about anatomic variations within the first extensor compartment [40].
  • Ultrasound is a worthwhile preoperative investigation in case of de Quervain's disease [41].
  • Styloid abnormalities do not affect the outcome of management for de Quervain's disease [10].

Anatomical Variations

  • Anatomic variations in the first extensor compartment are clinically relevant in the pathophysiology and treatment of De Quervain's tenosynovitis [1].
  • The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome [20].
  • When the extensor pollicis brevis tendon is associated with thumb interphalangeal joint extension, it is likely to reside in a subcompartment of the first dorsal compartment, particularly in patients with de Quervain's disease [46].

Treatment

Non-Operative

  • Injection of corticosteroids is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis and is the preferred initial treatment [2].
  • One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners lead to short-term improvement in participants with de Quervain's tenosynovitis compared to placebo [19].
  • Corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections [13].
  • Pain and clinical outcomes significantly improved after corticosteroid injection in de Quervain's disease [29].
  • Although the success rate for the treatment of De Quervain's tenosynovitis decreases with multiple injections, repeat injections have a high rate of success and are a viable clinical option [25].
  • Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients [27].
  • The effectiveness of each additional corticosteroid injection does not appear to diminish in patients with diabetes mellitus [27].
  • The presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection in de Quervain’s syndrome [17].
  • Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [8].
  • Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values [5].
  • The practice of obtaining routine wrist radiography prior to surgeon evaluation is wasteful as patients do not benefit from the resulting radiologic data [7].

Operative

  • Longitudinal incision offers the advantage of easy identification of the compartment, more complete releases of tendon sheath and peritendinous adhesions, and less risk of palmar subluxation of tendons [6].
  • The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity [12].
  • Endoscopic release of the extensor compartment is an effective and safe procedure in patients with de Quervain's disease who are unresponsive to nonoperative treatments [28].
  • Endoscopic release of the first extensor compartment is associated with a slight increase in operation time compared to open release [28].
  • Pulley reconstruction should be considered part of the surgical treatment for de Quervain tenosynovitis and gives satisfactory medium-term results [4].
  • Anatomic variations are frequently encountered in recalcitrant cases of de Quervain tenosynovitis [50].
  • Examples of anatomic variations encountered in recalcitrant cases include multiple slips of the abductor pollicis longus and the extensor pollicis brevis in its own separate compartment [50].
  • Outcomes for surgical treatment of de Quervain tenosynovitis are generally excellent [50].
  • Complications of surgical treatment for de Quervain tenosynovitis include iatrogenic injury to the superficial branch of the radial nerve, tendon subluxation, complex regional pain syndrome, and recurrence due to incomplete release [50].
  • The dorsal retinaculum is released during surgical treatment to prevent volar tendon subluxation [50].
  • Surgical decompression should be considered if corticosteroid injection fails [17].
  • The volarly based retinacular flap must remain over the released tendons to prevent volar tendon subluxation during surgical release [15].
  • The first dorsal compartment is opened on its dorsoulnar side during surgical release [15].
  • If the abductor pollicis longus and extensor pollicis brevis tendons cannot be easily retracted from the radial styloid, the surgeon should look for additional “aberrant” tendons and separate compartments [15].
  • Releasing the extensor pollicis brevis tendon first and then the abductor pollicis longus usually reveals the presence or absence of a septum [15].
  • If there is no extensor pollicis brevis present, the surgeon should inspect the floor of the compartment for the footprint of the brachioradialis tendon [15].
  • The brachioradialis tendon has a Y-shaped tendinous insertion, and if this is clearly seen, release of this compartment is assured [15].
  • Resection of a pronounced septum is warranted during surgical release, ensuring not to injure the underlying radial artery coursing dorsally just beyond the radial styloid [15].

Complications

Anatomical Variations and Surgical Risks

  • The longitudinal incision technique creates a longer area in which skin scar may make cutaneous nerves more subject to scar adherence [15].
  • The radial artery courses dorsally just beyond the radial styloid and must be avoided during septum resection [15].
  • The volarly based retinacular flap must remain over the released tendons to prevent volar tendon subluxation [15].
  • A longitudinal incision offers a less risk of palmar subluxation of tendons compared to other approaches [6].

Diagnostic and Anatomical Complications

  • Finkelstein's test is a descriptive error that can produce a false positive [9].
  • Extensor pollicis longus tenosynovitis can mimic de Quervain's disease because of its course through the first extensor compartment [9].
  • The prevalence of a separate compartment for the extensor pollicis brevis is significantly higher in patients with unsatisfactory non-operative outcomes than in the general population [32].
  • An intracompartmental septum is present in a mean 43% of wrists in cadaveric studies, with a range of 20 to 75% across different series [17].
  • Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis compared to nondiabetic patients [27].

Recovery

Non-Operative

  • Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis [14].
  • According to the limited evidence available, injection of corticosteroids is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis and is therefore the preferred initial treatment [2].
  • Corticosteroid injections lead to treatment success 73.4% of the time within 2 injections [13].
  • Most informed patients initially elect symptomatic treatment for de Quervain's disease, and most experience symptom resolution within one year [33].

Operative

  • Endoscopic release for de Quervain's tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release [30].
  • Pulley reconstruction should be considered part of the surgical treatment for de Quervain tenosynovitis, as the technique gives satisfactory medium-term results [4].

Patient Factors and Prognosis

  • Patients who scored lower than 40 for physical function or higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis [23].
  • More negative perceptions of the consequences of de Quervain's tenosynovitis and worse pain catastrophizing are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression [21].

Key Evidence

  • [L4] These variations are clinically relevant in the pathophysiology and treatment of De Quervain's tenosynovitis. [1] (10.1016/j.bjps.2016.08.020)
  • [L4] According to the limited evidence available, injection of corticosteroids is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis and is therefore the preferred initial treatment. [2] (10.1016/j.jhsa.2008.12.030)
  • [L4] [3] (10.1177/1758998315599796)
  • [L4] The authors believe the technique gives satisfactory medium-term results and should be considered part of the surgical treatment for de Quervain tenosynovitis. [4] (10.1055/s-0035-1556862)
  • [L3] Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values. [5] (10.1097/corr.0000000000001577)
  • [L4] Surgical release of De Quervain's tenosynovitis remains the gold standard treatment, and longitudinal incision offers advantage of easy identification of compartment, more complete releases of tendon sheath and peritendinous adhesions and less risk of palmar subluxation of tendons. [6] (10.1007/s12306-018-0585-1)
  • [L3] The practice of obtaining routine wrist radiography prior to surgeon evaluation is wasteful as patients do not benefit from the resulting radiologic data. [7] (10.1055/s-0037-1606124)
  • [L4] Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management. [8] (10.1016/j.jhsg.2024.01.009)
  • [L4] [9] (10.1016/j.jhsa.2014.09.024)
  • [L4] Though considered as a manifestation of de Quervain's disease by some authors, styloid abnormalities do not affect the outcome of management as proved in this study. [10] (10.1007/s11552-010-9258-8)
  • [L4] [11] (10.1054/jhsb.1999.0277)
  • [L4] The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity. [12] (10.4055/cios.2014.6.4.405)
  • [L3] This study indicates that corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections. [13] (10.1177/1558944716681976)
  • [L1] Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis. [14] (10.1016/j.jhsa.2024.03.003)
  • [L3] [17] (10.1177/1753193415611414)
  • [L4] In cases with symptoms of de Quervain's syndrome where the constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised. [18] (10.2106/00004623-194931040-00019)
  • [L1] One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners leads to improvement in the short term in participants with de Quervain's tenosynovitis when compared to placebo. [19] (10.1186/1471-2474-10-131)
  • [L4] The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome. [20] (10.1177/17531934231214137)
  • [L3] More negative perceptions of the consequences of de Quervain's tenosynovitis and worse pain catastrophizing are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression of de Quervain's tenosynovitis. [21] (10.1097/corr.0000000000000992)
  • [L4] Patients who scored lower than 40 for physical function or higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis. [23] (10.1016/j.jhsa.2023.07.005)
  • [L2] Although the success rate for the treatment of De Quervain's tenosynovitis decreases with multiple injections, repeat injections have a high rate of success and are a viable clinical option. [25] (10.1016/j.jhsa.2021.04.018)
  • [L1] [26] (10.1002/14651858.cd005616.pub2)
  • [L4] Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients, but the effectiveness of each additional injection does not appear to diminish. [27] (10.1016/j.jhsa.2022.02.018)
  • [L4] Endoscopic release of the extensor compartment seems to be an effective and safe procedure in patients with de Quervain's disease who are unresponsive to nonoperative treatments, despite a little increase in operation time. [28] (10.1016/j.bjps.2011.05.015)
  • [L1] Pain and clinical outcomes significantly improved after corticosteroid injection in de Quervain's disease. [29] (10.1016/j.otsr.2019.11.015)
  • [L1] Endoscopic release for de Quervain's tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release. [30] (10.1302/0301-620x.95b7.31486)
  • [L2] [31] (10.1016/j.jhsa.2008.08.020)
  • [L4] Most informed patients initially elect symptomatic treatment for de Quervain's disease, and most experience symptom resolution within one year. [33] (10.1007/s12593-009-0018-3)
  • [L2] [35] (10.1177/1753193412475043)
  • [L4] [37] (10.1055/s-0040-1716522)
  • [L3] [38] (10.1055/s-0038-1626690)
  • [L3] This finding may question the validity of using the asymptomatic thumb as a standard measure to identify the symptomatic thumb's impairments associated with de Quervain's disease. [39] (10.1197/j.jht.2008.03.004)
  • [L5] Ultrasound is a useful imaging technique for diagnosing de Quervain's disease and provides important information about anatomic variations within the first extensor compartment. [40] (10.1136/bcr-2021-242173)
  • [L4] Ultrasound is a worthwhile preoperative investigation in case of de Quervain's disease. [41] (10.1007/s12593-009-0001-z)
  • [L3] The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients with De Quervain tenosynovitis. [42] (10.1177/1558944718810864)
  • [L4] [43] (10.1177/0363546504268134)
  • [L4] In vivo EPB tendon excursion measures have been quantified, and wrist position has been found to have an influence on excursion. [44] (10.1016/j.jht.2017.12.004)
  • [L4] When it does, particularly in patients with de Quervain's disease, it is likely to reside in a subcompartment of the first dorsal compartment. [46] (10.1016/j.jhsa.2008.12.015)
  • [L3] Those subjects demonstrate a significant decrease in maximum velocity in slow fist tasks, highlighting the need for comprehensive assessment to ascertain the full extent of functional limitations that can occur in the setting of hand pathology. [48] (10.1177/1558944717729218)
  • [L2] The anatomical findings are consistent with previous studies, with an expectation to encounter the superficial branch of the radial nerve in more than 50% of patients. [58] (10.1055/s-0039-1688700)

References

[1] Surgical anatomy of the first extensor compartment: A systematic review and comparison of normal cadavers vs. De Quervain syndrome patients. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2017. DOI: 10.1016/j.bjps.2016.08.020

[2] Nonsurgical Treatment for de Quervain's Tenosynovitis. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.030

[3] De Quervain’s syndrome: It may not be an isolated pathology. Hand Therapy. 2015. DOI: 10.1177/1758998315599796

[4] Pulley Reconstruction As Part of the Surgical Treatment for de Quervain Disease: Surgical Technique with Medium-Term Results. Journal of Wrist Surgery. 2015. DOI: 10.1055/s-0035-1556862

[5] Are Patient Expectations and Illness Perception Associated with Patient-reported Outcomes from Surgical Decompression in de Quervain’s Tenosynovitis?. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001577

[6] Functional outcome of De Quervain’s tenosynovitis with longitudinal incision in surgically treated patients. MUSCULOSKELETAL SURGERY. 2019. DOI: 10.1007/s12306-018-0585-1

[7] Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients. Journal of Wrist Surgery. 2017. DOI: 10.1055/s-0037-1606124

[8] De Quervain’s Tenosynovitis: As Seen from the Perspective of the Patient. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.01.009

[9] Longitudinal Split Tear of the Extensor Pollicis Brevis Tendon: Report of 2 Cases. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.09.024

[10] Does Radial Styloid Abnormality in de Quervain's Disease Affect the Outcome of Management?. HAND. 2010. DOI: 10.1007/s11552-010-9258-8

[11] De Quervain’s Disease. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0277

[12] Surgical Release of the First Extensor Compartment for Refractory de Quervain's Tenosynovitis: Surgical Findings and Functional Evaluation Using DASH Scores. Clinics in Orthopedic Surgery. 2014. DOI: 10.4055/cios.2014.6.4.405

[13] Effectiveness of Corticosteroid Injections for Treatment of de Quervain’s Tenosynovitis. HAND. 2016. DOI: 10.1177/1558944716681976

[14] Advancements in de Quervain Tenosynovitis Management: A Comprehensive Network Meta-Analysis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.03.003

[15] Campbell S Operative Orthopaedics 4 Volume Set. EXCISION OF NECROTIC MUSCLES COMBINED WITH NEUROLYSIS OF MEDIAN AND ULNAR NERVES FOR SEVERE CONTRACTURE > SURGICAL TREATMENT OF DE QUERVAIN DISEASE.

[17] Presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection in de Quervain’s syndrome. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415611414

[18] AN UNUSUAL FORM OF DE QUERVAINʼS SYNDROME. The Journal of Bone & Joint Surgery. 1949. DOI: 10.2106/00004623-194931040-00019

[19] Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. BMC Musculoskeletal Disorders. 2009. DOI: 10.1186/1471-2474-10-131

[20] Prediction of an intracompartmental septum and its effect on outcomes of endoscopic release for de Quervain’s syndrome. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231214137

[21] Which Psychological Variables Are Associated With Pain and Function Before Surgery for de Quervain’s Tenosynovitis? A Cross-sectional Study. Clinical Orthopaedics & Related Research. 2019. DOI: 10.1097/corr.0000000000000992

[23] Association of Patient-Reported Outcomes Measurement Information System Measures With Injection and Surgical Treatment Response in Patients With De Quervain Tenosynovitis. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.07.005

[25] De Quervain Tenosynovitis: An Evaluation of the Epidemiology and Utility of Multiple Injections Using a National Database. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.04.018

[26] Corticosteroid injection for de Quervain's tenosynovitis. Cochrane Database of Systematic Reviews. 2009. DOI: 10.1002/14651858.cd005616.pub2

[27] Effectiveness of Corticosteroid Injections in Diabetic Patients With De Quervain Tenosynovitis. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.02.018

[28] Does endoscopic release of the first extensor compartment have benefits over open release in de Quervain’s disease?. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2011. DOI: 10.1016/j.bjps.2011.05.015

[29] Prospective randomized comparison of ultrasonography-guided and blind corticosteroid injection for de Quervain's disease. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2019.11.015

[30] Endoscopicversusopen release in patients with de Quervain’s tenosynovitis. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b7.31486

[31] Incidence of de Quervain's Tenosynovitis in a Young, Active Population. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.08.020

[32] Treatment of de Quervain tenosynovitis. A prospective study of the results of injection of steroids and immobilization in a splint.. The Journal of bone and joint surgery. American volume. 1991.

[33] Patient-centered care of de Quervain’s disease. Journal of Hand and Microsurgery. 2009. DOI: 10.1007/s12593-009-0018-3

[35] 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. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193412475043

[37] Are Plain X-Rays Necessary in the Diagnosis of De Quervain's Tenosynovitis?. Journal of Wrist Surgery. 2020. DOI: 10.1055/s-0040-1716522

[38] Finkelstein's Test Is Superior to Eichhoff's Test in the Investigation of de Quervain's Disease. Journal of Hand and Microsurgery. 2018. DOI: 10.1055/s-0038-1626690

[39] Bilateral_Thu_mb's_Active_Range_of_Motion_and_Strength_in_de_Quervain's_Disease_S0894113008000483. Journal of Hand Therapy. 2008. DOI: 10.1197/j.jht.2008.03.004

[40] Type II de Quervain’s disease: depicting subcompartmentalisation with ultrasound. BMJ Case Reports. 2021. DOI: 10.1136/bcr-2021-242173

[41] Preoperative ultrasound in de Quervain’s disease: an investigation worth doing. Journal of Hand and Microsurgery. 2009. DOI: 10.1007/s12593-009-0001-z

[42] Prevalence of a Septated First Dorsal Compartment Among Patients With and Without De Quervain Tenosynovitis: An In Vivo Anatomical Study. HAND. 2018. DOI: 10.1177/1558944718810864

[43] De Quervain Disease in Volleyball Players. The American Journal of Sports Medicine. 2005. DOI: 10.1177/0363546504268134

[44] Ultrasound assessment of extensor pollicis brevis tendon excursion in different wrist positions in healthy people. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2017.12.004

[46] Thumb Interphalangeal Joint Extension By the Extensor Pollicis Brevis: Association With a Subcompartment and de Quervain's Disease. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.015

[48] Dynamic Functional Assessment of Hand Motion Using an Animation Glove: The Effect of Stenosing Tenosynovitis. HAND. 2017. DOI: 10.1177/1558944717729218

[50] Miller S Review Of Orthopaedics. 2. Flexor tendon injury > 5. de Quervain tenosynovitis (Fig. 7.35).

[58] A Prospective Evaluation of the Anatomy of the First Dorsal Compartment in Patients Requiring Surgery for De Quervain's Tenosynovitis. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-1688700

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