DeQuervain's Syndrome 727.04

synonyms:

DeQuarvain's ICD-9

• 727.04

DeQuarvain's Etiology / Epidemiology / Natural History

• Stenosing tenosynovitis of the 1st dorsal compartment of wrist. 

DeQuarvain's Anatomy

• First dorsal compartment: contains the abductor pollicis longus (APL) and extensor pollis brevis (EPB) tendons.
• EPB frequently travels in a separate compartment which must be released during surgery.

DeQuarvain's Clinical Evaluation

• Pain/tenderness over the 1st dorsal compartment/radial aspect of wrist.  Worsened with thumb movement.
• Finkelstein test=pain in 1st compartment when wrist is ulnarly deviated with thumb flexed in palm. (Finkelstein H, JBJS 1930;12:509)
• Most common in women 30-50.  New mothers, housekeepers, athletes requiring forceful grasping coupled with ulnar deviation or repetitive thumb use (golf, fly fishing, racquet sports, javelin).
• Note

DeQuarvain's Xray / Diagnositc Tests

• P/A, lateral and Roberts (hyperpronated) wrist films indicated to rule out thumb CMC arthritis.

DeQuarvain's Classification / Treatment

• Acute: thumb spica splint, nsaids, acitivity modification.
• Subacute (patients who have failed acute management): Corticosteriod injection into first dorsal compartment. 
• Chronic (patients who have 2 or more injections): Surgical release of first dorsal compartment. The EPB frequently has separate compartment which must be released.
• CPT 25000: Incision, extensor tendon sheath, wrist (deQuervain's)

DeQuarvain's Associated Injuries / Differential Diagnosis

• Carpometacarpal arthritis
• Wartenberg's Syndrome

DeQuarvain's Complications

• Continued pain
• Superficial radial nerve palsy
• Tendinous adhesions
• Hypertrophic scarring
• Volar tendon subluxation

DeQuarvain's Follow-up Care

• Thumb spica splint for 6 weeks.
• Sutures removed at 10 day follow-up visit.

DeQuarvain's Review References