De Quervain's Tenosynovitis

• Sharp, aching pain at the radial (thumb) side of the wrist, at or just above the radial styloid
• Pain that radiates proximally toward the forearm or distally toward the thumb
• Swelling over the radial styloid
• A creaking or squeaking sensation (crepitus) with thumb motion
• Weakness with pinching and gripping
• Difficulty with activities involving thumb and wrist motion: lifting a baby, turning a key, pouring from a carafe, opening a jar, using a smartphone

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Finkelstein Test: The most specific clinical test for De Quervain's. The patient folds the thumb into the palm, wraps the fingers over the thumb, and the examiner or patient passively deviates the wrist toward the ulnar side (little finger side). A positive test reproduces the patient's pain over the first dorsal compartment. The Eichhoff variant (patient performs the maneuver themselves) is commonly used in clinical practice.

Note: A positive Finkelstein test is sensitive but not perfectly specific. It can also be positive in intersection syndrome and CMC arthritis, which must be distinguished clinically.

Physical Examination:

• Point tenderness directly over the first dorsal compartment at the radial styloid
• Swelling or a palpable thickening of the tendon sheath
• Reduced thumb abduction and extension strength

Imaging:

• X-rays: Routine to exclude radial styloid fracture, CMC arthritis, or scaphoid pathology.
• Ultrasound: Can directly visualize tendon sheath thickening, fluid, and identify the presence of a separate EPB sub-compartment. This is useful for injection guidance and pre-operative planning.
• MRI: Reserved for cases where the diagnosis is uncertain or when intersection syndrome, scaphoid pathology, or SLIL injury needs to be excluded.

Differentials to exclude:

• Intersection syndrome: Inflammation where the APL and EPB cross over the radial wrist extensors (ECRL/ECRB), located 4–6 cm proximal to the wrist. Produces pain higher up the forearm with a characteristic crunching crepitus ("squeaker's wrist").
• CMC (basal thumb) arthritis: Pain centered at the thumb CMC joint, positive grind test; co-exists with De Quervain's in some patients.
• Wartenberg's syndrome: Entrapment of the superficial radial sensory nerve; produces burning, dysesthetic symptoms rather than movement-dependent tendon pain.

• After injection: Mild flare for 24–48 hours; improvement typically noted within 1–2 weeks. Continue thumb spica splint during recovery.
• After surgery: A light thumb-spica splint is worn for 10–14 days. Sutures removed at 10–14 days; light grip activities begin. Scar massage at 2 weeks. Most patients return to office/desk work within 2 weeks and full activities (including return to new-parent lifting) by 4–6 weeks. Formal hand therapy is prescribed if stiffness or scar sensitivity develops.