De Quervain’s Tenosynovitis (radial‑styloid tenosynovitis)
A stenosing tendinopathy of the first dorsal compartment of the wrist in which the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons are restricted beneath the extensor retinaculum. Presents with radial‑sided wrist pain aggravated by thumb movement and gripping. Common in primary and emergency care - recognise it, exclude mimics, provide analgesia and arrange appropriate follow‑up or referral.
Administrative note
- Record the diagnosis as “radial‑styloid tenosynovitis (De Quervain)” for coding where required (ICD/OPCS M65.4).
Epidemiology
- Incidence approximately 1 per 1,000 person‑years.
- More common in women aged 30-50 and typically affects the dominant wrist.
- Risk factors include repetitive thumb/wrist use, sports (golf/tennis), postpartum childcare, and prior trauma.
Anatomy and pathophysiology
- The first dorsal compartment (at the radial styloid) contains the APL and EPB tendons which glide beneath the extensor retinaculum.
- Pathology involves thickening/stenosis of the tendon sheath and retinaculum, causing tendon friction; histology may show degenerative (mucoid) change and synovial thickening.
- The superficial branch of the radial nerve runs nearby and is vulnerable during injections or surgery.
Clinical presentation
- Gradual onset of radial‑styloid pain, worse with thumb abduction/extension, gripping, and ulnar deviation of the wrist.