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DeQuervain's Tenosynovitis M65.4 727.04

 

synonyms:1st extensor tenosynovitis, baby wrist, dequerivain's disease, dequarvain's tenosynovitis

DeQuarvain's ICD-10

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.  Reproduction of the patients pain is diagnositc of de Quervain's Tenosynovitis. (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).

DeQuarvain's Xray / Diagnositc Tests

  • P/A, lateral and Roberts (hyperpronated) wrist films indicated to rule out thumb CMC arthritis. Evaluate for calcifications in the area of the first dorsal compartment as well as post-traumatic deformity of the radial styloid.

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

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