If there is no pain, the examiner then passively deviates the wrist. In acute presentations this may be enough to elicit pain and the assessment can be halted. This manoeuvre starts with the patient actively ulnarly deviating their wrist over the edge of a table. 9 In their 2010 article, Dawson et al describe a staged approach to Finkelstein’s test, 9 which may help to eliminate this. 10 The contralateral side should always be assessed, as false-positive results can be seen with this manoeuvre in patients with asymptomatic wrists. Pain is caused by the restricted glide of the tendons as they lie in their now narrower compartment. 12 Eichoff’s test is very similar but requires the patient to hold their own thumb into flexion using their other fingers while deviating the wrist into ulnar deviation. 11 A positive test will elicit pain along the radial wrist when the thumb is held into flexion across the palm and the wrist is moved into ulnar deviation by the examiner (Figure 1). 8 Finkelstein’s test, first described in 1930, has long been used by clinicians in suspected cases of De Quervain’s tenosynovitis. 9 Physical examination may reveal tenderness on palpation over the first dorsal compartment 10 if swelling is present, it is usually 1–2 cm proximal to the radial styloid following the course of the EPB and APL tendons. 8 Patients often report difficulties with activities that involve grasping, twisting and lifting. Patients present with pain and swelling over their radial styloid that is exacerbated with thumb motion and wrist deviation. 5 Those with a septum will need both compartments surgically released therefore, it is important to identify the septum pre-operatively. 1,6 Those with an unidentified septum will not respond as well to corticosteroid injections 1,6 because only one compartment tends to be injected. 1,6 Many authors link the presence of a septum to an increased likelihood of developing De Quervain’s tenosynovitis and also to the success of different treatment types. The prevalence of a septum ranges from 24% to 91% in the literature. Many studies have looked at anatomical variations and at the prevalence of an intercompartmental septum within the first dorsal compartment. Histopathology may also show signs of chronic overuse within the tendon substance resulting in myxoid degeneration. It is important to note that this increase in vascularity in the tendons is not associated with inflammation or tissue repair and is responsible for some of the pain experienced with this condition. Neovascularisation is also seen in patients with De Quervain’s tenosynovitis. ![]() 3 Thickening of the tendon sheath and therefore narrowing of the tunnel occurs because of the presence of fibrocartilage, which is a response to the shear and compression forces placed on the tendons. 4 This tunnel lies over the radial styloid and under the extensor retinaculum, which can cause tendon gliding difficulties and entrapment of the tendons when thickening of the sheath occurs. They lie within a closed fibrous sheath or tunnel with a synovial lining 3 that is approximately 2.2 cm in length. The first dorsal compartment comprises the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL) tendons. 1 The extensor tendons are divided into six compartments as they cross the dorsum of the wrist. The pathophysiology of De Quervain’s tenosynovitis is generally defined in the literature as a stenosing condition of the first dorsal compartment. While the exact cause of De Quervain’s tenosynovitis is still debated, possible aetiologies include acute injuries (eg blunt trauma, biomechanical compression), forceful repetition of the wrist and thumb leading to increased frictional forces or microtrauma (eg workplace-related activity, actions performed by new mothers), inflammatory diseases, anatomical variations, abnormalities of the first dorsal compartment and, rarely, pathogens. 1 The prevalence of De Quervain’s tenosynovitis in adults of working age (18–65 years) in the general population is approximately 1.3% of women and 0.5% of men, with peak prevalence at the age of 40–60 years. While there are many reasons for radial wrist pain, De Quervain’s tenosynovitis is a common pathology and is described as stenosing tenosynovitis of the tendons within the first dorsal compartment of the wrist.
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