De Quervain's Tenovaginitis
De Quervain's is a stenosing tenosynovitis of the 1st Dorsal Extensor Compartment of the wrist. It is a common cause of radial-sided wrist pain ("Mommy's Thumb").
1. Anatomy
- Tendons Involved: Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB). (Mnemonic: "All Peanut Butter").
- Site: Radial Styloid Process.
2. Clinical Features
- Pain: Over radial styloid, aggravated by thumb movement.
- Finkelstein's Test: Patient makes a fist with thumb inside fingers. Examiner ulnar deviates the wrist. Sharp pain = Positive.
- Eichhoff's Test: Often confused with Finkelstein's, but creates false positives.
3. Management
- Conservative: Thumb Spica Splint, NSAIDs, Steroid Injection (90% success).
- Surgical: Release of the 1st Dorsal Compartment sheath. Beware of the Radial Sensory Nerve.
25 Practice MCQs
Q1. Which tendons are involved in De Quervain's?
Answer: A). 1st Dorsal Compartment.
Q2. Finkelstein's Test involves:
Answer: A). Stretches the inflamed tendons over the styloid.
Q3. Which nerve is at risk during surgery or injection?
Answer: A). Runs right over the 1st compartment.
Q4. "Intersection Syndrome" occurs:
Answer: A). About 4-8cm proximal to Lister's tubercle. Causes crepitus.
Q5. Common demographic for De Quervain's is:
Answer: A). "Mommy's Thumb" or "Washerwoman's Sprain".
Q6. The 1st Dorsal Compartment is located over:
Answer: A). Bony prominence aggravates friction.
Q7. Splint of choice is:
Answer: A). Must immobilize both wrist and thumb to rest the tendons.
Q8. A separate sub-compartment often exists for:
Answer: A). Failure to release this septum causes surgical failure.
Q9. Wartenberg's Syndrome mimics De Quervain's but is:
Answer: A). Positive Tinel's sign over the nerve.
Q10. The APL usually has how many tendon slips?
Answer: A). Variation is common.
Q11. Is it inflammatory?
Answer: A). Though steroids help, pathology shows myxoid degeneration.
Q12. Volar subluxation of tendons can occur if:
Answer: A). Complication of aggressive release.
Q13. Differential diagnosis includes:
Answer: A). Grind test helps differentiate.
Q14. Eichhoff's Test is considered:
Answer: A). It can cause pain in normal wrists. Finkelstein is usually step-wise.
Q15. Steroid injection may cause:
Answer: A). Warning for dark-skinned patients.
Q16. WHAT test (Wrist Hyperflexion and Abduction of Thumb) helps rule out De Quervain's?
Answer: A). Another specific test.
Q17. EPL runs in which compartment?
Answer: B). It is NOT involved in De Quervain's.
Q18. Gliding exercises for APL/EPB should be:
Answer: A). Irritation worsens the stenosis.
Q19. Trigger thumb involves:
Answer: B). Volar side pathology.
Q20. Success rate of surgery is:
Answer: A). If all compartments are released.
Q21. Is it bilateral?
Answer: A). Especially in new mothers.
Q22. Does X-ray help?
Answer: A). Rule out CMC OA.
Q23. "Wet Leather" crepitus is sign of:
Answer: A). Distinct feeling on palpation.
Q24. Eccentric loading is used in rehab:
Answer: A). Helps align collagen fibers.
Q25. Texting Thumb is:
Answer: A). Modern etiology.
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