De Quervain Tenosynovitis: The Daily PANCE Blueprint
A 34-year-old woman who gave birth 8 weeks ago presents with 3 weeks of pain on the thumb side of her right wrist that is worst when she lifts her baby. There was no fall or other injury, and she has no numbness or tingling. On examination, she has tenderness and mild swelling over the radial styloid. Which examination maneuver is most likely to reproduce her pain?
A. Tapping over the volar wrist crease
B. Holding both wrists in full flexion for 60 seconds
C. Rotating the thumb metacarpal while pressing it against the trapezium
D. Pressing into the anatomic snuffbox
E. Deviating the wrist toward the ulna with the thumb tucked into a fist
Answer and topic summary
The answer is E. Deviating the wrist toward the ulna with the thumb tucked into a fist
This is de Quervain tenosynovitis, inflammation of the abductor pollicis longus and extensor pollicis brevis tendons in the first dorsal compartment. It is classic in the months after childbirth, from lifting an infant over and over, and in anyone with repetitive thumb and wrist use. The Finkelstein test (the patient tucks the thumb into a fist and the examiner deviates the wrist toward the ulna) reproduces sharp pain over the radial styloid; strictly speaking, that version is the Eichhoff maneuver, but boards and clinicians call it Finkelstein. Tinel sign at the wrist and the Phalen maneuver check for carpal tunnel syndrome, which causes numbness in the median nerve distribution rather than radial wrist pain. The grind test is for thumb carpometacarpal arthritis, felt at the base of the thumb in older patients. Snuffbox tenderness after a fall on an outstretched hand points to a scaphoid fracture. Treatment is a thumb spica splint, NSAIDs, and activity changes, with a corticosteroid injection into the first dorsal compartment if symptoms persist.
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