De Quervain disease

Although traditionally called a tenosynovitis, the pathology is a degenerative stenosing tendinopathy, with thickening and myxoid fibrocartilaginous change of the tendon sheath rather than a a simple inflammatory process.

Anatomical variation is common: multiple slips of the abductor pollicis longus, a separate extensor pollicis brevis subcompartment, or a septum within the first dorsal compartment may influence symptoms, injection success, and operative treatment.

Diagnosis is primarily clinical, based on radial styloid tenderness, pain with thumb movement or resisted thumb abduction/extension, and provocative manoeuvres such as the Finkelstein test, Eichhoff test, or WHAT tests.

Plain radiographs do not confirm de Quervain disease, but may help exclude other causes of radial wrist pain such as thumb carpometacarpal osteoarthritis. Ultrasound is the most useful imaging adjunct, particularly for identifying first-compartment septation or tendon-sheath thickening and for guiding injection. MRI is not routinely required, but may be useful when symptoms are atypical, diagnosis is uncertain, or alternative pathology is suspected. Current imaging evidence remains limited, and ultrasound is the most frequently studied modality.

Initial treatment includes activity modification, thumb-spica splinting, analgesia/anti-inflammatory measures, and corticosteroid injection. Surgical release is reserved for persistent or recurrent cases.

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History of de Quervain disease

1825 / 1841 – Alfred Velpeau (1795–1867) described painful crepitating tenosynovitis of the fibro-synovial tendon sheaths at the wrist. In 1825, he localised the disorder to the sheath containing the long abductor and short extensor of the thumb with swelling, pain on thumb movement, and palpable crepitus. In 1841, he named the condition crépitation douloureuse des tendons and recorded the Gascon term laï / ay. A precursor to, but not the same as, de Quervain disease.

1877 – Paul Jules Tillaux (1834-1904) described ténosite crépitante ou d’aï in the tendon sheaths of the thumb, particularly the long abductor and short extensor. He described swelling along the tendons, crepitus during thumb movement, severe pain limiting motion and improvement after rest. Like Velpeau he defined painful crepitating overuse tenosynovitis, rather than chronic stenosing tendovaginitis. French eponym: Aïe crépitant de Tillaux.

1893 – Henry Gray (1825-1861) described washerwoman’s sprain, an overuse-related crepitating tenosynovitis of the thumb extensor tendon sheaths in the 13th edition of Anatomy, Descriptive and Surgical.

The tendons of the Extensor muscles of the thumb are liable to become strained, and their sheaths inflamed, after excessive exercise, producing a sausageshaped swelling along the course of the tendon and giving a peculiar creaking sensation to the finger when the muscle acts. In consequence of its often being caused by such movements as wringing clothes, it is known as ‘washerwoman’s sprain.’

Gray 13th Edition, 1893

1895 – Fritz de Quervain (1868–1940) published Ueber eine Form von chronischer Tendovaginitis, defining chronic stenosing tendovaginitis at the radial styloid. He described pain and tenderness over the tendon-sheath compartment of the abductor pollicis longus and extensor pollicis brevis, noted absence of crepitus, and demonstratesd that operative release or excision could relieve symptoms.

De Quervain acknowledged that Theodor Kocher (1841–1917) had previously seen similar cases, treated them by partial excision, and suggested the term “fibrous, stenosing tendovaginitis”. However, de Quervain’s 1895 paper became the defining and eponymous account.

1898 – Phil Hoffmann described a common, undescribed affection of the extensor muscles of the thumb. His 12 cases had radial styloid pain aggravated by thumb extensor stretch or contraction, often after repetitive work. His description included the thumb extensor group more broadly and did not clearly define de Quervain’s first dorsal compartment stenosis.

I must acknowledge that I do not understand the pathology of these cases… I suspect their character to be that of a chronic, non-tubercular thecitis.

Phil Hoffmann, 1898

1912 – de Quervain published a follow-up article with eight additional operative cases. He warned that the disease should not be confused with tendovaginitis crepitans, and described the first dorsal compartment as “too narrow for the two tendons,” with the tendons bulging out when the compartment was opened.

1927 – Eichhoff described a manoeuvre of placing the thumb inside the fist and ulnar-deviating the wrist. This later became confused with Finkelstein’s test and is often incorrectly taught as the “Finkelstein test”

1930 – Harry Finkelstein (1883–1975) published Stenosing tendovaginitis at the radial styloid process, reviewing the literature and reporting 24 operated cases. He emphasised that de Quervain disease was often misdiagnosed as rheumatism, neuritis, periostitis, nonspecific tenosynovitis, or tuberculous osteitis. He described the original Finkelstein test:

On grasping the patient’s thumb and quickly abducting the hand ulnarward, the pain over the styloid tip is excruciating. This is probably the most pathognomonic objective sign.

Finkelstein 1930

1958 – Brazilian orthopaedic surgeon Luiz Leão published de Quervain’s Disease: A Clinical and Anatomical Study. He reviewed the history of the syndrome and reported dissections of 50 wrists from 27 fresh cadavers. Leão documented frequent anatomical variation in the first dorsal compartment, including double grooves, separate synovial sheaths, and multiple slips of the abductor pollicis longus.

In the same paper, Leão stated that Finkelstein had “transcribed the test described by Eichhoff in 1927” and then described the test as placing the thumb within the clenched fingers followed by ulnar deviation of the wrist. This was Eichhoff’s manoeuvre, not Finkelstein’s original test. This has contributed to significant confusion in the literature.

1992 – Barry G. Elliott corrected the Finkelstein–Eichhoff confusion in Finkelstein’s test: A descriptive error that can produce a false positive. He distinguished Finkelstein’s original thumb-grasp test from Eichhoff’s thumb-in-fist ulnar deviation manoeuvre. Elliott warned that the erroneous version could produce false positives and inappropriate surgery.

2014 – Goubau et al. introduced the WHAT test as wrist hyperflexion and active thumb abduction, the modern provocative test for de Quervain disease.

2020 – Morgan et al. published A Review of De Quervain’s Stenosing Tenovaginitis in the Context of Smartphone Use. The review found an association between intensive texting, internet browsing, gaming, and positive provocative testing. However, the evidence supported association rather than direct causation. A modern occupational injury compared with earlier descriptions of washerwomen, typists, pianists, and manual labourers.

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Associated Persons

• Alfred Velpeau (1795–1867) – crépitation douloureuse des tendons
• Paul Jules Tillaux (1834-1904) – aïe crépitant de Tillaux
• Fritz De Quervain (1868-1940) – De Quervain disease
• Harry Finkelstein (1883–1975) – Finkelstein test

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Alternative names

• de Quervain disease; de Quervain’s syndrome
• de Quervain’s tenosynovitis; de Quervain’s tendovaginitis

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References

Original articles

• Velpeau AF. Article XXIII: Crépitation douloureuse des tendon. In: Leçons Orales de Clinique Chirurgicale. 1841: 567-574
• Tillaux PJ. Région externe du poignet. In: Traité d’anatomie topographique avec applications à la chirurgie. 1877: 600-602
• Gray H. Anatomy, Descriptive and Surgical. 13th Edition. Philadelphia: Lea Bros & Co, 1893: 467
• de Quervain F. Ueber eine Form von chronischer Tendovaginitis. Correspondenz-Blatt für Schweizer Aerzte, Basel, 1895; 25: 389-394. [Translation: On a form of chronic tendovaginitis by Dr. Fritz de Quervain in la Chaux-de-Fonds. 1895. Am J Orthop. 1997;26(9):641-4.
• Hoffman P. A common, undescribed affection of the extensor muscles of the thumb. Transactions of the American Orthopedic Association 1898; 11: 252-256.
• de Quervain F. Veber das Wesen und die Behandlung der stenosierenden Tendovaginitis am Processus styloideus radii. Münchener Medizinische Wochenschrift 1912; 59: 5–6.
• Eichhoff E. Zur Pathogenese der Tendovaginitis stenosans. Bruns’ Beiträge zur klinischen Chirurgie 1927; 139: 746-755
• Finkelstein H. Stenosing tendovaginitis at the radial styloid process. JBJS 1930, 12: 509-540.
• Leao L. De Quervain’s disease; a clinical and anatomical study. J Bone Joint Surg Am. 1958 Oct;40-A(5):1063-70.
• Elliott BG. Finkelstein’s test: A descriptive error that can produce a false positive. J Hand Surg Br. 1992;17(4):481-2

Review articles

• Keyes HB. Stenosing tendovaginitis at the radial styloid process. Ann Surg. 1938 Apr;107(4):602-6. 
• Potter PC. Stenosing tendovaginitis at the radial styloid process (DeQuervain’s disease). Ann Surg. 1943 Feb;117(2):290-6. 
• Stein AH Jr, Ramsey RH, Key JA. Stenosing tendovaginitis at the radial styloid process (DeQuervain’s disease). AMA Arch Surg. 1951 Aug;63(2):216-28.
• Younghusband OZ, Black JD.. De Quervain’s Disease: Stenosing Tenovaginitis at the Radial Styloid Process Can Med Assoc J. 1963 Sep 7;89(10):508-12.
• Brunelli G. Le test de Finkelstein contre le test de Brunelli dans la tenosynovite de De Quervain [Finkelstein’s versus Brunelli’s test in De Quervain tenosynovitis]. Chir Main. 2003 Feb;22(1):43-5.
• Ahuja NK, Chung KC. Fritz de Quervain, MD (1868-1940): stenosing tendovaginitis at the radial styloid process. J Hand Surg Am. 2004 Nov;29(6):1164-70.
• Arandes Renú JM. Estenosis la primera corredera o enfermedad de De Quervain. Historia. Revista Iberoamericana de Cirugía de la Mano 2010; 38(01): 011-013
• Morgan SD, Sivakumar BS, An VG, Sevao J, Graham DJ. A Review of De Quervain’s Stenosing Tenovaginitis in the Context of Smartphone Use. J Hand Surg Asian Pac Vol. 2020 Jun;25(2):133-136.
• Ramchandani J, Thakker A, Tharmaraja T. Time to Reconsider Occupation Induced De Quervain’s Tenosynovitis: An Updated Review of Risk Factors. Orthopedic Reviews. 2022;14(3).
• Fakoya AO, Tarzian M, Sabater EL, Burgos DM, Maldonado Marty GI. De Quervain’s Disease: A Discourse on Etiology, Diagnosis, and Treatment. Cureus. 2023 Apr 24;15(4):e38079.
• Stadnick M. De Quervain’s Tenosynovitis. MRI Web Clinic – November 2024