Overview Snapshot A 32-year-old secretary presents with pain over the radial side of her right wrist. She denies any history of wrist trauma. Her pain is aggravated by carrying her 3-month-old son. She is swollen and tender over the radial styloid. Finkelstein test is positive. Radiographs are normal without signs of osseous abnormalities. Introduction Clinical definition stenosing tenosynovial inflammation of the first dorsal compartment tendons abductor pollicis longus (APL) extensor pollicis brevis (EPB) Epidemiology incidence common cause of radial-sided wrist pain demographics women more likely than men adults more likely than children risk factors repetitive wrist motion new mothers and day care workers caused by frequent lifting of babies assembly line workers secretaries golfers and racquet sports players traumatic wrist injury Etiology posttraumatic overuse injury Pathoanatomy normal anatomy wrist has 6 dorsal compartments ordered from radial to ulnar 1 - abductor pollicis longus (APL) and extensor pollicis brevis (EPB) 2 - extensor carpi radialis longus (ECRL) and brevis (ECRB) 3 - extensor pollicis longus (EPL) 4 - extensor digitorum communis (EDC) and extensor indices (EI) 5 - extensor digiti minimi (EDM) 6 - extensor carpi ulnaris (ECU) extensor retinaculum overlies the dorsal compartments pathophysiology extensor retinaculum thickens and swells leading to friction with tendon movement Prognosis 90% will resolve within 1 year Presentation Symptoms radial-sided wrist pain aggravated by thumb and wrist motion Physical exam Finkelstein test ulnar deviation of the hand with the thumb flexed elicits pain tenderness at radial styoid along APL and EPB tendons no tenderness proximally along APL and EPB muscle bellies Imaging Radiography indications needed to rule out bony conditions that could be causing radial sided wrist pain findings normal in De Quervain tenosynovitis as condition is limited to soft tissues (e.g., tendons and fascia) Differential Osteoarthritis of the 1st carpometacarpal joint (base of the thumb) distinguishing factors will demonstrate osteoarthritic changes at the base of the thumb on radiography typically presents over months to years Intersection syndrome (tenosynovitis where the 1st and 2nd dorsal compartments cross) distinguishing factors pain is less radial and more proximal than De Quervain tenosynovitis (2 inches proximal to the wrist) Treatment Nonoperative rest, NSAIDs, splinting, and steroid injection indication first-line treatment technique thumb spica splint steroid injections into first dorsal compartment Operative surgical release of 1st dorsal compartment indications severe disease that does not improve with non-operative management Complications Superficial radial nerve injury surgical complication due to nerve passing directly over first dorsal compartment supplies sensory function along radial thumb Neuroma