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De Quervain Tenosynovitis — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyDe Quervain TenosynovitisSCE Rheumatology

A 45-year-old woman has a 3-week history of bilateral pain over the radial styloids, aggravated by gripping and thumb movement. Examination shows focal tenderness over each first dorsal extensor compartment, and the Finkelstein manoeuvre reproduces her pain. There is no preceding trauma, neurological deficit or synovitis elsewhere. What is the most appropriate initial management?

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Correct answer: B — Activity modification, thumb-spica splinting and appropriate analgesia

The correct answer is B. The focal radial-styloid pain provoked by thumb movement and a positive Finkelstein manoeuvre is typical of de Quervain tenosynovitis involving the first dorsal extensor compartment. With short-duration, uncomplicated symptoms, initial UK management is activity modification, thumb-spica immobilisation and appropriate analgesia. If symptoms remain troublesome, local corticosteroid injection is effective and may be combined with a short period of splinting. Immediate surgery is reserved for persistent symptoms despite non-operative treatment. Systemic prednisolone exposes the patient to unnecessary systemic toxicity, while tendon fenestration is not standard treatment for this stenosing tenosynovitis. Exercises may subsequently assist rehabilitation, but physiotherapy without activity modification or splinting is not the best initial option.

Reference: North Tees and Hartlepool NHS Foundation Trust. Hand Therapy – De Quervain’s Tenosynovitis: Inflammation of the Tendons of the Thumb. Page reviewed 31 March 2026. https://www.nth.nhs.uk/resources/hand-therapy-de-quervains-tenosynovitis-inflammation-of-the-tendons-of-the-thumb/