tay.generalcomments@nhs.scot

De Quervain's Tenosynovitis

Symptoms and Signs

  • Cause generally unknown and pathological process poorly understood. 
  • Affects abductor pollicis longus and extensor pollicis brevis tendons in first dorsal compartment at the styloid process of the radius causing pain, tenderness, and swelling over the radial aspect of the wrist.
  • Pain on extension/abduction of thumb, may be associated with crepitus on movement. 
  • Difficulty lifting/gripping due to pain.
  • Most common in women aged 30-50. Can occur 4-6 weeks post-partum due to repetitive lifting. 
  • Maybe associated with ganglion
  • Pain with Finklestein’s /Eichhoff’s tests, or wrist hyperflexion and abduction of the thumb (WHAT) test.
  • Non progressive, self-limiting condition - 82% resolve within 12 months

Initial Management

Conservative management:
  • Modification of activity
  • Analgesia & NSAIDs as appropriate
  • Splints (wrap around thumb splint) can be bought from Boots/Allardyce/online
  • Corticosteroid injection (CSI) into 1st dorsal compartment can be done by appropriately trained healthcare professional. Refer to MSK physiotherapy if injection not done in the GP Practice. 
  • Where onward referral to the Hand Service is required, this will be made by the Physiotherapy Service directly. 

Useful Resources

De Quervain's Patient Leaflet (NHS Fife) 

Who to Refer

  • Consider referral to secondary care hand surgery team for surgical opinion only if symptoms present for more than a year, and failure to respond to injection/conservative treatment and patient is aware of all risks, including recurrence rate, (10%) post op time off work (up to 6 weeks) and happy for surgery.
  • Remind patients likely to resolve within a year

Who not to refer

Symptoms less than one year with no conservative treatment tried. 

How to refer

  • If being seen by MSK physiotherapy service, onward referral to hand service will be organised by Physiotherapist.
  • SCI Gateway/Hand Service. Patients will be appointed to Advanced Practice Physiotherapist initially.  

Include the following information:
  • Duration of symptoms and any cause of onset
  • Conservative management tried (e.g. any relief through activity avoidance/ splintage/ physiotherapy/ steroid injection?)
  • Movement loss
  • Functional limitations, effect on work/hobbies. Dominance
  • Pain severity (constant/ intermittent/ waking at night)
  • Any associated crepitus on thumb movements/ ganglion