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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 presents with atraumatic pain and focal tenderness over the radial styloid. The pain is reproduced when her thumb is held within her palm and the wrist is deviated towards the ulna. What is the most likely diagnosis?

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Correct answer: E — De Quervain tenosynovitis

The diagnosis is **De Quervain tenosynovitis**, a stenosing disorder of the first dorsal extensor compartment involving the abductor pollicis longus and extensor pollicis brevis tendons. Radial-styloid tenderness and pain provoked by enclosing the thumb in the palm and ulnarly deviating the wrist are characteristic. A ganglion would usually present as a discrete swelling rather than this movement-provoked tendon pain. Rheumatoid arthritis generally causes synovitis affecting multiple wrist or hand joints and prolonged inflammatory stiffness. A scaphoid fracture usually follows trauma and produces anatomical snuffbox or scaphoid-tubercle tenderness. Trigger finger affects a flexor tendon at the palmar metacarpophalangeal region and causes catching or locking of a digit, not radial-sided wrist pain.

Reference: NHS Greater Glasgow and Clyde, MSK Index: De Quervain's, Diagnosis and presentation/Clinical testing, last reviewed 2024. https://www.rightdecisions.scot.nhs.uk/ggc-msk-index/hand/de-quervains/