De Quervain tendinopathy occurs when there is swelling and injury often from overuse of the wrist injuring the extensor pollicis brevis and abductor pollicis longus. Patients often report wrist pain over the radial side of the wrist. The pain can be reproduced when the thumb is put in a closed fist and the wrist is then put in ulnar deviation(termed Finkelstein test). The diagnosis can be made clinically and does not require advanced imaging. Initial management is centered on avoiding the exacerbating activity. Patients can be placed in a thumb spica splint, which can further aid in healing. Symptomatic treatment with NSAIDs, heat, and ice is also appropriate. Severe cases refractory to initial measures may be treated with local steroid injections.
An MRI wrist (A) may demonstrate inflammation and injury to the extensor pollicis brevis and the abductor pollicis longus. However, it is not a part of the routine workup of de Quervain tendinopathy, which can be diagnosed clinically and typically completely resolves with activity modification and placement of a thumb spica splint. A plain film of the wrist (C) may be indicated for trauma to the wrist if there is concern for a bony injury. There was no trauma in this patient or focal bony tenderness. A steroid injection (D) is only indicated for severe cases of de Quervain tendinopathy that are refractory to conservative management, such as splinting and NSAIDs. Steroid injections should be used sparingly as they may alleviate symptoms acutely but worsen outcomes in the long run or with repeat injections.