Introduction
De Quervain's disease is a stenosing tenosynovitis of the first dorsal compartment of the wrist, affecting the tendons of m. abductor pollicis longus and m. extensor pollicis brevis. It is a classic overuse condition on the thumb side of the wrist and a common occupational complaint. This note covers its causes, the sheath changes behind the pain, clinical features, diagnosis, treatment, and how it is assessed for work ability.
Definition and anatomy
The condition is also known as washerwoman's sprain, mother's wrist or radial styloid tenosynovitis. The two tendons run together through a fibro-osseous tunnel over the radial styloid, held down by the extensor retinaculum. The sheath in this tunnel is narrow, so any thickening of the sheath or tendon makes the tendons rub painfully against the walls of the tunnel.
Etiology and risk factors
The two main causes are repetitive thumb movement and repetitive eccentric wrist lowering into ulnar deviation under load.
- Repeated forceful pinch, grip and thumb extension or abduction, for example in assembly, packing, sewing or manual sorting
- Lowering a load while the wrist is held in ulnar deviation, such as repeatedly lifting and setting down heavy objects by the hand
- Female sex, middle age, pregnancy and the postpartum period, when fluid retention and hormonal changes increase susceptibility
- Direct trauma to the radial styloid and systemic conditions such as diabetes, although occupational load is the usual trigger