Synopsis
Recognise first dorsal-compartment tenosynovitis from radial wrist pain, distinguish intersection, joint, fracture and nerve disorders, and deliver thumb-specific splinting, progressive rehabilitation, injection and referral safely.
- De Quervain tenosynovitis causes radial-styloid pain and tenderness worsened by thumb abduction or extension, gripping, lifting and wrist deviation.
- The WHAT or carefully performed Finkelstein-type manoeuvre reproduces first-compartment pain, but a provocative test does not replace exact localisation or trauma history.
- First-line investigation is clinical examination; routine radiographs and ultrasound are unnecessary when the pattern is typical and no trauma, mass or inflammatory features exist.
Key red flags
A fall with anatomical-snuffbox or scaphoid-tubercle tenderness requires a scaphoid injury pathway even when initial radiographs are normal.
Investigation priorities
Reproduce first-compartment pain and distinguish thumb-base joint, scaphoid, intersection and superficial radial-nerve disease.
Management branches
Atraumatic radial-styloid pain follows a typical pattern without fracture, infection, mass or neurological deficit.
- Explain which combined thumb and wrist movements overload the compartment and modify those tasks temporarily.
- Fit a thumb-spica that supports wrist and thumb without compressing the radial sensory nerve.
Key medicines
Topical diclofenac gelFor each application to intact radial-wrist skin, use 2–4 g of diclofenac 1.16% gel; apply up to three or four times daily for a brief trial without passing the licensed maximum.
First dorsal-compartment corticosteroid injectionUnder an aseptic trained protocol, give one dose such as triamcinolone acetonide 10–20 mg into the tendon-sheath compartment, using ultrasound when septation or previous failure is suspected, and avoid intratendinous placement.