Dequervain’s Tendonitis

What is Dequervains tendonitis?

Dequervains tendonitis is a common overuse tendonitis that occurs on the radial or thumb side of the wrist.

The dorsum, or back of the wrist, has 6 distinct extensor tendon compartments. Each compartment contains one or several extensor tendons. The first dorsal compartment is the most radial. The first dorsal compartment contains the abductor pollicis longus (APL)and the extensor policis brevis (EPB). These tendons are responsible for extending the thumb and moving it away from the palm. In Dequervains tenosynovitis, there is inflammation in this compartment causing pain and swelling.

How does Dequervains tendonitis occur?

Common causes of Dequervains tenosynovitis are repetitive overuse or direct trauma. This condition is common in mothers or caretakers of newborns because of wrist positioning during nursing and carrying a baby. A direct blow or repetitive things like using a screwdriver can also create inflammation in the first dorsal compartment.

Diagnosing Dequervains tendonitis

Patients present with swelling and tenderness over the wrist below or proximal to the thumb. Some patients may note a bump or ganglion cyst in that area. Movement of the thumb and wrist can be painful. Patients may have a positive Finkelstein’s test which involves placing the thumb in the palm with a closed fist and bending the wrist in ulnar deviation (towards the small finger). If this causes pain, the Finkelstein’s test is positive. Patients may have pain that radiates up the forearm to the elbow. It is important for Dr. Kavi Sachar to perform a physical exam if you may have this condition. Other conditions that may have similar symptoms include thumb arthritis and other forms of tendonitis.

Treating Dequervains tendonitis

Treatment consists of rest, splints, anti-inflammation, and avoidance of the the activity that causes it if possible. Therapy may be helpful. For example, holding a baby with more of a football grip and less of a wrist grip may help. Occasionally, corticosteroid injections are performed. These are often helpful and may cure the condition. If treated early, Dequervains tendonitis may resolve without surgical treatment.

Surgery is reserved for severe cases. In surgery, the first dorsal compartment is divided to make more room for the APL and EPB tendons. This is often done under either a local or regional anesthetic. By dividing the ligament, more room is created for the tendons and this allows for smooth gliding without impingement. The tendons can maintain their position and function because Dr. Kavi Sachar only divides the roof of the tunnel and leaves the walls intact. The wound is closed with an invisible sutures.

After surgery, patients are splinted for a short amount of time and normal activity is resumed within 2-3 weeks. If necessary, surgery is very successful.

Schedule a consultation

Board-certified and fellowship-trained hand surgeon Dr. Kavi Sachar is widely regarded as one the nation’s leading experts on Dequervains tendinitis. Dr. Sachar has three office locations in Vail, Aspen, and Frisco, Colorado. If you or a family member suffer from Dequervains tendinitis , contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.