De-Quervains is a common cause for radial sided wrist pain.
It’s a stenosing tenovaginalitis of the 1st extensor compartment (containing Abductor Pollicis Longus and Extensor Pollicis Brevis).
It is more common in women, especially after birth of a child. 30-50 yr olds.
Pain and Swelling on the radial side of wrist, 1-2 cms proximal to radial styloid.
+ ve Finkelsteins test = pain with thumb in palm, fingers wrapped over and wrist ulna deviated.
Normally a clinical diagnosis. Ultrasound can be helpful in showing fluid in the 1st extensor compartment, as well as tendon sheath thickening and restricted tendon glide.
As with all conditions, start with simple treatment options and work up the therapeutic ladder as required.
When to refer
Attempt at conservative management is definitely worth trying initially. A fairly large proportion can be treated successfully with rest, splints and injections.
Please refer to earlier section on steroid injections.
What’s the Evidence ?
Saki et al Orthopaedics Jan 2002:- 53 Patients, 46 have relief after 1 injection, 6 more after 2, 1 more after 3. i.e everyone successful. Lower rate of success in diabetics.
How to Inject