Ténosynovite de De Quervain

Abstract

De Quervain's tenosynovitis is an inadequacy between the abductor pollicis longus and extensor pollicis brevis tendons and the osteo-fibrous tunnel in the first extensor compartment of the wrist. It usually arises in women between 40 and 50 years old and is often related to tendon overuse in sports, especially volley-ball, but is also seen in manual workers and housekeepers. The changes in histopathological appearances in the tendon sheath make us believe that De Quervain's disease is a result of intrinsic degenerative mechanisms rather than extrinsic, inflammatory ones. The main clinical feature is pain around the radial styloid process, exacerbed by movements of the thumb and by passive ulnar deviation of the wrist with the thumb flexed maximally (Finkelstein's test). Among the different tests, ultrasound seems to be a fast and efficient way to confirm the suspected diagnosis and to provide follow-up of lesions. It can confirm the presence of an intertendinous septum and provide guidance at the time of steroid injection. It can increase the rate of conservative management by demonstrating the presence of septum. The medical management consists indeed on corticoids infiltrations of the first extensor compartment, the avoidance of repetitive and stress movement of the first ray with the use of a rest splint. The surgical approach is considered with the recurrence of the painful symptoms in spite of a well-done medical management. The classical surgical technique consists in a simple section of the pulley, but can have postoperative complications. These complications can be avoided by new conservative procedures.