De Quervain's Tenosynovitis

AKA Texting Thumb or DeQuervain’s Syndrome

Explore De Quervain's tenosynovitis, or "Texting Thumb." Understand symptoms, causes, the Finkelstein test, and treatment options for effective relief from thumb and wrist pain.

texting thumb

 by Allan Strongwater, M.D.

De Quervain syndrome is an inflammatory disorder affecting the tendons of the first dorsal extensor compartment of the hand.

Upon physical examination, there is tenderness along the abductor pollicis longus and the extensor pollicis brevis tendons in the compartment. Swelling of the compartment is often present. Resisted thumb extension elicits pain as seen in the Finkelstein test (holding the wrist in radial deviation, flexing the thumb metacarpophalangeal [MCP] joint and interphalangeal [IP] joint into the palm, and closing the fist over the flexed thumb). The wrist is then deviated ulnarly. The test is positive if ulnar deviation causes pain. There is a high degree of correlation between a positive Finkelstein test and de Quervain syndrome.

Signs and Symptoms

Patients often complain of pain in the thumb with motion of the MCP and/or interphalangeal IP joints of the thumb. The pain may radiate proximally to the wrist, and ulnar deviation of the wrist may exacerbate the pain. Patients may also complain of swelling at the base of the thumb and along the course of the two extensor tendons. Tenderness is apparent along the abductor pollicis longus and the extensor pollicis brevis tendons in the compartment. Swelling of the compartment is often present. Resisted thumb extension elicits pain as seen in the Finkelstein test.

Causes and Risk Factors

De Quervain syndrome may result from a number of etiologies. Women are affected more often than men. There is a higher observed incidence during and immediately after pregnancy. Tenosynovitis has been reported following trauma to the region of the dorsum of the first metacarpal, injuring the two tendons (the abductor pollicis longus and the extensor pollicis brevis) in the first extensor compartment of the hand. Mechanical overload, most commonly due to repetitive activities, may induce the tenosynovitis as is seen in "texting thumb." Systemic inflammatory diseases (eg, rheumatoid arthritis) may trigger tenosynovitis of the first extensor compartment, resulting in de Quervain syndrome.

Diagnostic Evaluation

The Finkelstein test is used during physical examination to elicit the diagnosis. The test is positive if ulnar deviation causes pain. Radiographs of the hand should be obtained to rule out other pathology, including stress fracture.

Treatment Options

De Quevain syndrome may be treated like other inflammatory tenosynovitis. Some cases of de Quervain syndrome spontaneously heal and become asymptomatic. Initial treatment should include avoidance of activities that exacerbate the pain. Splinting of the thumb and wrist has been used, but its efficacy is questionable. Additional studies are needed. Medications, including anti-inflammatory medications and acetaminophen, are useful to control pain and reduce inflammation. More resistant cases may be relieved with steroid injection into the tendon sheaths. In resistant, severe, disabling, de Quervain syndrome unresponsive to the above measures, surgical decompression of the compartment and tendons may be necessary.