Tenosinovitis de De Quervain

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 and Diagnosis¶

• Anatomical variations in the first extensor compartment are clinically relevant to the pathophysiology and treatment of De Quervain's tenosynovitis [1].
• Wrist radiography does not influence the management of patients presenting with de Quervain tendinopathy [6].
• The tethered thumb sign is a clinical maneuver that supports the diagnosis of de Quervain tenosynovitis and assists in determining an effective treatment algorithm [12].
• Ultrasound can be used as a diagnostic tool in the management of de Quervain’s disease [18].

Non-Operative Treatment¶

• Corticosteroid injection is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis and is the preferred initial treatment [2].
• Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis [28].
• Corticosteroid injections lead to treatment success 73.4% of the time within 2 injections [22].
• 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 [46].
• Corticosteroid injection for De Quervain tenosynovitis is not as effective in patients with metabolic syndrome compared with age- and sex-matched controls in terms of functional outcomes and treatment failure [5].
• Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients [40].
• The effectiveness of each additional corticosteroid injection does not appear to diminish in patients with diabetes mellitus [40].
• Ultrasound-guided triamcinolone injection should be considered to improve the treatment outcome for de Quervain's disease [18].

Operative Treatment¶

• Surgical release of De Quervain's tenosynovitis remains the gold standard treatment [10].
• Surgical intervention is effective as definitive therapy for de Quervain's tenosynovitis, with a cure rate of 91% and 88% of patients indicating full satisfaction [11].
• The release of the first extensor compartment for refractory de Quervain's disease results in good clinical outcomes with minimal morbidity [24].
• 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 [10].
• The longitudinal incision for release of the first extensor compartment is a safe and effective technique that provides good exposure, protects vital structures, prevents possible tendon subluxation in the postoperative period, and is cosmetically acceptable [17].
• 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 [33].
• One portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures [31].
• 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, despite a little increase in operation time [41].
• Pulley reconstruction should be considered part of the surgical treatment for de Quervain tenosynovitis and gives satisfactory medium-term results [4].

Prognosis and Patient Factors¶

• Patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [7].
• 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 [34].
• The failure of an operation in De Quervain tenosynovitis is due to anatomical variations, the involvement of the radial superficial nerve, and the ignoring of another syndrome in the proximity [13].
• Addressing misconceptions about de Quervain's tenosynovitis regarding consequences for patients and symptom duration allows patients to make informed decisions about treatment [9].

Anatomy & Pathophysiology¶

Anatomical Variations¶

• The first dorsal compartment of the wrist exhibits immense anatomical variation, including commonly found supernumerary tendons or tendon slips [107].
• Variation in tendon insertion is present in the population of the first dorsal compartment [107].
• Septa or aberrant compartments are present in the first dorsal compartment [107].
• Bilateral variations are present in the population regarding the anatomy of the first dorsal compartment [107].
• 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 [94].

Pathophysiology¶

• De Quervain's syndrome is defined as a condition where the abductor pollicis longus and extensor pollicis brevis tendons in the first dorsal compartment become inflamed through friction within a tight osteoligamentous tunnel [3].
• Compromised blood flow and nutrition in the first dorsal compartment lead to the development of adhesions and tendon stenosis [3].
• De Quervain's syndrome may involve myxoid degeneration, defined as a degenerative process where connective tissues are replaced by a gelatinous or mucoid substance [3].
• The pathophysiology of De Quervain's disease does not involve inflammation, with histopathological examination showing predominant degenerative changes such as myxoid degeneration and fibrocartilagenous metaplasia [38].
• De Quervain's tenosynovitis is caused by impaired gliding of the abductor pollicis longus and extensor pollicis brevis tendons [38].
• Impaired gliding in De Quervain's tenosynovitis is most probably caused by thickening of the extensor retinaculum of the wrist [38].
• 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].
• Operative treatment for distal radius fractures confers a slightly greater risk of developing De Quervain tenosynovitis within 1 year of injury or surgery [105].

Clinical Presentation & Assessment¶

• De Quervain's tenosynovitis is characterized by pain, tenderness, and swelling over the thumb side of the wrist at the radial styloid process [38].
• The condition is especially associated with sideward movements of the wrist and often leads to impairment of thumb function [38].
• The tethered thumb sign is a clinical maneuver that can support the diagnosis of De Quervain tenosynovitis and assist in determining an effective treatment algorithm [12].
• Subjects with stenosing tenosynovitis demonstrate a significant decrease in maximum velocity in slow fist tasks [81].
• In vivo extensor pollicis brevis tendon excursion measures have been quantified, and wrist position has been found to have an influence on excursion [73].
• The proportion of wrists with a positive extensor pollicis brevis entrapment test was significantly higher among those with two compartments (18 of 22) than among those with one compartment (0 of 4) [97].

Etiology & Risk Factors¶

• Women are more affected by De Quervain tenosynovitis than men, potentially due to manual work such as housekeeping activities and child rearing influencing first compartment dynamics [72].
• Training intensity is a major factor in determining De Quervain disease in volleyball players, with patients in the higher intensity group showing a mean training time quotient of 155 compared to 74 in the lower intensity group [72].
• The close association of work and repetitive trauma with De Quervain’s disease has been observed, although the exact relationship is controversial [21].
• Recent studies have disputed the view that repetitive work is causative of De Quervain’s disease, with one review of 100 patients finding no increased incidence in the dominant hand [21].
• A study of workers in a car plant reported 544 cases of tenosynovitis but only 2 cases of De Quervain’s disease [21].
• Repetitive work is less contentious as a factor in aggravating symptoms, as tendon movement within a stenosed sheath during activity logically causes pain [21].
• The process of tendon movement within a stenosed sheath may cause tendon damage through wear and tear, potentially leading to tendon rupture [21].

Complications & Associated Pathology¶

• Rupture of the abductor pollicis longus tendon in association with De Quervain’s disease has never been reported in the literature prior to the 2006 case report [21].
• Volar subluxation of the tendons of the first dorsal compartment can occur after surgery for De Quervain's stenosing tenosynovitis [48].
• Volar tendon subluxation after De Quervain's release can be treated with a distally based flap of the brachioradialis tendon to prevent tendon prolapse [48].
• Symptomatic palmar tendon subluxation after surgical release for De Quervain's disease can be avoided by leaving a palmarly based flap of extensor retinaculum [15].
• Dorsal tendon dislocation after De Quervain's release can occur if the patient overstresses the wrist through forceful extension [80].
• Repeat provocative testing for volar tendon subluxation following De Quervain’s release revealed volar tendon translation with wrist flexion, with no pain reported [85].
• Osteoid osteoma of the radial styloid can mimic stenosing tenosynovitis, with correct diagnosis often requiring histological examination when clinical presentation and X-rays are not typical [45].

Classification¶

Anatomical Variations and Subcompartmentalization¶

• The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients with De Quervain tenosynovitis [52].
• In a prospective study of 87 wrists, 22 of 30 patients (73%) who failed non-operative treatment and underwent operative release were found to have a separate compartment for the extensor pollicis brevis [55].
• The prevalence of a separate compartment for the extensor pollicis brevis in patients failing non-operative treatment is significantly higher than that in the general population, as shown in anatomical studies of cadavers [55].
• The persistence of an intracompartmental septum between the abductor pollicis longus and extensor pollicis brevis tendons has been described in a mean 43% of wrists in cadaveric studies, with a wide variation ranging from 20 to 75% [39].
• When the extensor pollicis brevis tendon resides in a subcompartment, it is likely to do so particularly in patients with de Quervain's disease [53].
• Ultrasound is a useful imaging technique for diagnosing de Quervain's disease and provides important information about anatomic variations within the first extensor compartment [50].
• The presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound-guided steroid injection in de Quervain’s syndrome [39].

Diagnostic Mimics and Associated Pathologies¶

• Extensor pollicis longus tenosynovitis caused by the extensor pollicis longus's unusual course through the first extensor compartment is a very rare condition that mimics de Quervain’s disease [30].
• An osteoid osteoma of the radial styloid can mimic stenosing tenosynovitis, with correct diagnosis often requiring histological examination when clinical presentation and X-rays are not typical [45].
• A hemangioma of the extensor pollicis brevis in the first dorsal compartment is an unusual cause of bilateral de Quervain's disease [14].
• De Quervain’s syndrome may not be an isolated pathology, with potential associations to trauma, extensor carpi ulnaris involvement, ligament instability, and repetitive strain [3].
• Failure of surgical treatment in De Quervain tenosynovitis can be attributed to anatomical variations, the involvement of the radial superficial nerve, and the ignorance of another syndrome in the proximity [13].
• The complexities of de Quervain's tendinitis and the diagnosis and treatment of associated diseases and complications are described to help prevent surgical failures and prolonged disabilities in working women [8].

Clinical Presentation and Physical Examination¶

• Triggering or locking in extension is an uncommon symptom in de Quervain’s stenosing tenosynovitis, with a prevalence of 1.3% based on a review of 827 consecutive patients [20].
• A new test for evaluating the first extensor compartment is a useful clinical tool in the diagnosis of De Quervain's tenosynovitis [36].
• Ultrasound can be used as a diagnostic tool in the management of de Quervain’s disease, in addition to improving treatment outcomes [18].

Epidemiology and Risk Factors¶

• In a young, active population, the unadjusted incidence rate of de Quervain’s tenosynovitis was 0.94 per 1000 person-years [54].
• The adjusted incidence rate ratio for females compared to male patients was 4.45 (95% CI 4.28, 4.62) when controlling for race, age, service, and rank [54].
• The highest incidence rate of de Quervain’s tenosynovitis was seen in the ≥40-year-old group, with an incidence rate of 1.37 per 1000 person-years [54].
• 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) [54].
• 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 others compared to white race [54].
• De Quervain’s syndrome affects around 1.3% of women and 0.5% of men in a population of adults of working age [39].

Pathophysiology¶

• De Quervain’s syndrome is defined as a condition where the abductor pollicis longus and extensor pollicis brevis tendons in the first dorsal compartment become inflamed through friction, leading to compromised blood flow, nutrition, adhesions, and tendon stenosis [3].
• De Quervain’s syndrome may represent a myxoid degeneration, defined as a degenerative process in which connective tissues are replaced by a gelatinous or mucoid substance [3].
• The role of repetitive work in the causation of de Quervain’s disease is controversial, with some studies disputing it as a primary cause while acknowledging it may aggravate symptoms [21].
• Rupture of the abductor pollicis longus tendon in association with De Quervain’s disease has never been reported in the literature prior to the 2006 report [21].

Clinical Presentation¶

Symptoms and Signs¶

• Patients typically complain of soreness and tenderness on the radial side of the distal radius that is exacerbated by ulnar deviation of the thumb [59].
• Symptoms are also exacerbated by a strong grasp combined with flexion and radial deviation of the wrist or by a firm pinching together of the index finger and thumb [59].
• Physical examination reveals tenderness and swelling directly over the first dorsal compartment [59].

Diagnostic Testing¶

• De Quervain disease is diagnosed clinically and no imaging studies are required [64].
• Wrist radiography does not influence management of patients presenting with de Quervain tendinopathy [6].
• In a study of 200 patients, no radiographic findings altered the course of treatment in patients with isolated de Quervain's tenosynovitis [62].
• Wrist imaging is required only in the presence of associated processes that may need to be evaluated, such as previous distal radius or scaphoid fracture, arthritis of the thumb, and instability of the wrist [64].
• Ultrasound can be useful as a diagnostic tool in the management of de Quervain’s disease [18].
• Ultrasound is a worthwhile preoperative investigation in case of de Quervain's disease [51].
• The wrist hyperflexion and abduction of the thumb (WHAT) test is a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test [59].
• Finkelstein's test is superior to Eichhoff's test in the investigation of de Quervain's disease [63].
• A new clinical maneuver, the tethered thumb sign, can support the diagnosis of de Quervain tenosynovitis and assist in determining an effective treatment algorithm [12].

Differential Diagnosis and Mimics¶

• Extensor pollicis longus tenosynovitis caused by the EPL's unusual course through the first extensor compartment is a very rare condition that mimics de Quervain’s disease [30].
• Congenital synostosis between the scaphoid and the trapezium can cause tenosynovitis simulating de Quervain's disease [43].
• The failure of surgical treatment in De Quervain tenosynovitis can be due to anatomical variations, the involvement of the radial superficial nerve, and the ignoring of another syndrome in the proximity [13].
• 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 [27].

Patient Factors and Perception¶

• Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [7].
• Most informed patients initially elect symptomatic treatment for de Quervain's disease, and most experience symptom resolution within one year [32].
• 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 [25].
• 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 [9].

Investigations¶

Clinical Examination¶

• Finkelstein's test is described as a descriptive error that can produce a false positive [16].
• A staged description of the Finkelstein test has been proposed to address diagnostic accuracy issues [16].
• A new clinical test for evaluating the first extensor compartment is a useful tool in the diagnosis of De Quervain's tenosynovitis [36].
• In cases where symptoms suggest de Quervain's syndrome but constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised [27].

Imaging¶

• Deferring routine wrist radiography does not affect the management of de Quervain tendinopathy patients [6].
• Ultrasound is a useful imaging technique for diagnosing de Quervain's disease and provides information about anatomic variations within the first extensor compartment [50].
• Ultrasound is a worthwhile preoperative investigation in cases of de Quervain's disease [51].
• Radial styloid abnormalities do not affect the outcome of management for de Quervain's disease [19].
• An osteoid osteoma of the radial styloid can mimic stenosing tenosynovitis, and correct diagnosis may require histological examination when clinical presentation and X-rays are atypical [45].
• Congenital synostosis between the scaphoid and the trapezium can cause tenosynovitis that simulates de Quervain's disease [43].
• Extensor pollicis longus tenosynovitis caused by an unusual course through the first extensor compartment is a rare condition that mimics de Quervain’s disease [30].

Anatomical Variations¶

• Anatomical variations in the first extensor compartment are clinically relevant in the pathophysiology and treatment of De Quervain's tenosynovitis [1].
• The presence of an intracompartmental septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome [42].
• 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 [53].
• De Quervain's disease may be secondary to extensor pollicis brevis entrapment [29].

Patient Factors and Perception¶

• Addressing misconceptions about the consequences of de Quervain's tenosynovitis and symptom duration allows patients to make informed decisions about treatment [9].
• Growth hormone abuse is associated with a more recalcitrant form of de Quervain tenosynovitis that does not respond well to nonsurgical treatment, increasing the likelihood of surgical decompression [79].

Treatment¶

Non-Operative Management¶

• One or two local injections of 1 ml triamcinolone acetonide 10 mg/ml provided by general practitioners leads to short-term improvement in participants with de Quervain's tenosynovitis compared to placebo [26].
• Corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections [22].
• A single cortisone injection was effective in alleviating symptoms of de Quervain tendinopathy in 82% of patients, with over half remaining symptom-free for at least 12 months [67].
• The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes [68].
• 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 [40].
• Ultrasound should be considered to improve the treatment outcome of corticosteroid injections and can also be useful as a diagnostic tool in the management of de Quervain’s disease [18].
• Pain and clinical outcomes significantly improved after corticosteroid injection in de Quervain's disease [49].
• Preliminary results indicate that betamethasone is a superior treatment for De Quervain's tenosynovitis compared to ketorolac injection [70].
• Splinting has not been shown to provide long-lasting relief beyond allowing the joints to rest in an immobilized position [65].
• Iontophoresis with dexamethasone may improve functional outcomes, while therapeutic pulsed ultrasound may be effective in decreasing pain in patients with de Quervain's tenosynovitis [69].

Operative Management¶

• The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity [24].
• An oblique incision coursing along the extensor brevis tendon is preferred for surgical release, though transverse, oblique, or longitudinal incisions are also satisfactory [35].
• The longitudinal incision for release of the first extensor compartment 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 [10].
• The first dorsal compartment should be opened on its dorsoulnar side during surgical release [35].
• A volarly based retinacular flap must remain over the released tendons to prevent volar tendon subluxation [35].
• Symptomatic palmar tendon subluxation after surgical release can be avoided by leaving a palmarly based flap of extensor retinaculum to prevent palmar subluxation of the tendons with wrist flexion [15].
• Volar subluxation of the tendons of the first dorsal compartment after surgery can be treated with a distally based flap of the brachioradialis tendon [48].
• One portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments [31].
• 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 [41].
• Pulley reconstruction should be considered part of the surgical treatment for de Quervain tenosynovitis as it gives satisfactory medium-term results [4].
• The failure of an operation in De Quervain tenosynovitis is due to anatomical variations, the involvement of the radial superficial nerve, and the ignorance of another syndrome in the proximity [13].
• Anatomical variations are clinically relevant in the pathophysiology and treatment of De Quervain's tenosynovitis [1].
• Anatomic variations are frequently encountered in recalcitrant cases of de Quervain tenosynovitis, including multiple slips of APL and EPB in its own separate compartment [83].
• First dorsal compartment release during volar approach for distal radius fracture fixation reduces symptoms in patients with pre-existing De Quervain disease compared with no release [75].

Complications¶

Surgical Complications¶

• Surgical failure in De Quervain tenosynovitis is attributed to anatomical variations, involvement of the radial superficial nerve, and the failure to diagnose another syndrome in the proximity [13].
• Symptomatic palmar tendon subluxation is a complication of surgical release that can be avoided by leaving a palmarly based flap of extensor retinaculum [15].
• The longitudinal incision for release of the first extensor compartment prevents possible tendon subluxation in the postoperative period [17].
• Endoscopic release for de Quervain's tenosynovitis is associated with fewer superficial radial nerve complications compared with open release [33].
• The longitudinal incision offers a less risk of palmar subluxation of tendons compared to other approaches [10].

Tendon and Structural Complications¶

• Rupture of the abductor pollicis longus tendon in association with De Quervain’s disease has been reported, with pathogenesis potentially linked to ongoing tendon damage from wear and tear within the stenosed sheath [21].
• Longitudinal split tears of the extensor pollicis brevis tendon have been reported in cases of de Quervain's tenosynovitis [16].

Diagnostic and Associated Pathology¶

• De Quervain's syndrome may be associated with trauma, extensor carpi ulnaris involvement, ligament instability, or repetitive strain, indicating it may not be an isolated pathology [3].
• Extensor pollicis longus tenosynovitis caused by the EPL's unusual course through the first extensor compartment is a rare condition that mimics de Quervain’s disease [30].
• In cases where constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised to avoid diagnostic error [27].
• The complexities of de Quervain's tendinitis and associated diseases and complications are described to help prevent surgical failures and prolonged disabilities in working women [8].

Recovery¶

Non-Operative Management¶

• A single injection of steroid gives complete and lasting relief in 70% of patients with de Quervain's disease, and a further 10% will be cured by a second injection [91].

Operative Management¶

• Only 34.9% of patients with new stenosing tenosynovitis required surgery within a 2-year follow-up period, with most progressing to surgery within 1 year of presentation [93].

Surgical Technique and Complications¶

• Pulley reconstruction as part of the surgical treatment for de Quervain tenosynovitis gives satisfactory medium-term results and should be considered part of the surgical treatment [4].

Patient Factors and Prognosis¶

• 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 [25].

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] Although considerable improvements in symptom severity and hand function will likely occur in patients with metabolic syndrome, corticosteroid injection for De Quervain tenosynovitis is not as effective in these patients compared with age- and sex-matched controls in terms of functional outcomes and treatment failure. [5] (10.1177/1753193417694112)
• [L3] Wrist radiography does not influence management of patients presenting with de Quervain tendinopathy. [6] (10.1055/s-0037-1606124)
• [L4] Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management. [7] (10.1016/j.jhsg.2024.01.009)
• [L4] The complexities of de Quervain's tendinitis and the diagnosis and treatment of associated diseases and complications are described to help prevent surgical failures and prolonged disabilities in these groups of working women. [8] (10.1016/s0363-5023(87)80204-6)
• [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. [9] (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. [10] (10.1007/s12306-018-0585-1)
• [L4] Surgical intervention is effective as definitive therapy for de Quervain's tenosynovitis, with a cure rate of 91% and 88% of patients indicating full satisfaction. [11] (10.1053/jhsu.1999.1071)
• [L4] We can conclude that the failure of an operation in the De Quervain tenosynovitis is due to anatomical variations, the involvement of the radial superficial nerve, and the ignoration of another syndrome in the proximity. [13] (10.1177/1558944716660555gr)
• [L5] [14] (10.1016/s0363-5023(96)80112-2)
• [L5] This complication can be avoided by leaving a palmarly based flap of extensor retinaculum to prevent palmar subluxation of the tendons with wrist flexion. [15] (10.1016/s0363-5023(84)80017-9)
• [L4] [16] (10.1016/j.jhsa.2014.09.024)
• [L4] In our experience, the longitudinal incision for release of the first extensor compartment for de Quervain tenosynovitis is a safe and effective technique that provides good exposure, protects vital structures, prevents possible tendon subluxation in the postoperative period, and is cosmetically acceptable. [17] (10.1097/01.bth.0000181105.24124.c0)
• [L4] Therefore, ultrasound should not only be considered to improve the treatment outcome, but can also be useful as a diagnostic tool in the management of de Quervain’s disease. [18] (10.1016/j.main.2013.09.002)
• [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. [19] (10.1007/s11552-010-9258-8)
• [L4] Triggering or locking in extension is an uncommon symptom in de Quervain’s stenosing tenosynovitis, with a prevalence of 1.3% based on a review of 827 consecutive patients. [20] (10.1053/jhsu.1999.1311)
• [L4] [21] (10.1016/j.jhsb.2005.09.020)
• [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. [22] (10.1177/1558944716681976)
• [L4] The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity. [24] (10.4055/cios.2014.6.4.405)
• [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. [25] (10.1097/corr.0000000000000992)
• [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. [26] (10.1186/1471-2474-10-131)
• [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. [27] (10.2106/00004623-194931040-00019)
• [L1] Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis. [28] (10.1016/j.jhsa.2024.03.003)
• [L4] We conclude that de Quervain's disease is secondary to EPB entrapment. [29] (10.1016/s0363-5023(98)80160-3)
• [L5] Extensor pollicis longus tenosynovitis caused by the EPL's unusual course through the first extensor compartment is a very rare condition that mimics de Quervain’s disease. [30] (10.1016/j.jhsa.2003.11.012)
• [L4] One portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments. [31] (10.1016/j.aott.2018.10.004)
• [L4] Most informed patients initially elect symptomatic treatment for de Quervain's disease, and most experience symptom resolution within one year. [32] (10.1007/s12593-009-0018-3)
• [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. [33] (10.1302/0301-620x.95b7.31486)
• [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. [34] (10.1016/j.jhsa.2023.07.005)
• [L3] The new test is a useful clinical tool in the diagnosis of De Quervain's tenosynovitis. [36] (10.1016/j.main.2011.10.017)
• [L1] [38] (10.1002/14651858.cd005616.pub2)
• [L3] [39] (10.1177/1753193415611414)
• [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. [40] (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. [41] (10.1016/j.bjps.2011.05.015)
• [L4] The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome. [42] (10.1177/17531934231214137)
• [L5] We describe a case of nonsyndromic congenital fusion of the scaphoid and the trapezium as a cause of tendinitis simulating de Quervain's stenosing tenosynovitis, an association not previously reported. [43] (10.1016/s1297-3203(00)73478-0)
• [L5] As the clinical presentation and X-rays of the wrist were not typical of an osteoid osteoma, only the histological examination led to the correct diagnosis. [45] (10.1016/0266-7681(92)90100-g)
• [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. [46] (10.1016/j.jhsa.2021.04.018)
• [L4] [48] (10.1016/s0363-5023(10)80007-3)
• [L1] Pain and clinical outcomes significantly improved after corticosteroid injection in de Quervain's disease. [49] (10.1016/j.otsr.2019.11.015)
• [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. [50] (10.1136/bcr-2021-242173)
• [L4] Ultrasound is a worthwhile preoperative investigation in case of de Quervain's disease. [51] (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. [52] (10.1177/1558944718810864)
• [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. [53] (10.1016/j.jhsa.2008.12.015)
• [L2] [54] (10.1016/j.jhsa.2008.08.020)
• [L2] [59] (10.1177/1753193412475043)
• [L4] [62] (10.1055/s-0040-1716522)
• [L3] [63] (10.1055/s-0038-1626690)
• [L5] [64] (10.5435/00124635-200712000-00009)
• [L4] [65] (10.1007/s11552-014-9649-3)
• [L4] A single cortisone injection was effective in alleviating symptoms of de Quervain tendinopathy in 82% of patients, with over half remaining symptom-free for at least 12 months. [67] (10.1016/j.jhsa.2014.12.027)
• [L2] The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes. [68] (10.1016/j.jhsa.2013.10.013)
• [L4] This study demonstrated that iontophoresis with dexamethasone may improve functional outcomes, while therapeutic pulsed ultrasound may be effective in decreasing pain in patients with de Quervain's tenosynovitis. [69] (10.1016/j.jht.2014.08.032)
• [L1] Preliminary results indicate that betamethasone is a superior treatment for De Quervain's tenosynovitis. [70] (10.1016/j.jhsa.2017.06.086)
• [L4] [72] (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. [73] (10.1016/j.jht.2017.12.004)
• [L1] The current results demonstrated a significantly greater reduction in de Quervain disease symptoms in the release group compared with the no release group during the short-term follow-up. [75] (10.1016/j.jhsg.2024.03.009)
• [L3] Our results suggest that growth hormone abuse is associated with a more recalcitrant form of de Quervain tenosynovitis that does not respond well to nonsurgical treatment, thus leading to increased likelihood of surgical decompression. [79] (10.1177/0363546509337993)
• [L5] The patient overstressed his wrist through forceful extension during over-zealous weightlifting. [80] (10.1177/1753193419871862)
• [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. [81] (10.1177/1558944717729218)
• [L4] Repeat provocative testing revealed volar tendon translation with wrist flexion, with no pain reported. [85] (10.1097/bth.0000000000000054)
• [L4] A single injection of steroid gives complete and lasting relief in 70% of patients with de Quervain's disease, and a further 10% will be cured by a second injection. [91] (10.1016/s0363-5023(09)91110-8)
• [L2] Only 34.9% of patients with new stenosing tenosynovitis required surgery within a 2-year follow-up period, with most progressing to surgery within 1 year of presentation. [93] (10.1016/j.jhsa.2017.06.088)
• [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. [94] (10.1055/s-0039-1688700)
• [L3] The proportion of wrists with a positive EPB entrapment test was significantly higher among those with 2 compartments (18 of 22) than among those with 1 compartment (0 of 4). [97] (10.1053/jhsu.2002.35309)
• [Paper] Operative treatment for distal radius fractures confers a slightly greater risk of developing DeQuervain tenosynovitis within 1 year of injury or surgery. [105] (10.1177/15589447251366456)
• [Paper] There is immense anatomical variation present in the first dorsal compartment of the wrist, supernumerary tendons/tendon slips are commonly found, there is variation of insertion present in the population, septum/aberrant compartment is also present, and bilateral variations are present in the population. [107] (10.1007/s12593-012-0073-z)

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