# De Quervain Tenosynovitis > De Quervain tenosynovitis for NEET-PG Orthopaedics: APL and EPB in the first dorsal compartment, Finkelstein test, intersection syndrome, injection and release. - Canonical URL: https://prepelephant.com/topics/neet-pg/orthopaedics/dequervain-tenosynovitis - Exam / course: NEET-PG · Subject: Orthopaedics - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "De Quervain Tenosynovitis", PrepElephant, https://prepelephant.com/topics/neet-pg/orthopaedics/dequervain-tenosynovitis ## Direct answer Deep ache along the radial border of the wrist, worse when lifting a newborn or wringing laundry, marks stenosing tenosynovitis of the first dorsal extensor compartment — De Quervain disease — in which the abductor pollicis longus and extensor pollicis brevis tendons drag through a thickened, narrowed retinacular sheath beside the radial styloid. Women between 30 and 50 are the classic patients, and lactating mothers plus manual workers dominate Indian outpatient lists. The Finkelstein test — thumb clasped inside a fist, wrist passively deviated ulnar-ward — reproduces the pain and settles the diagnosis. First-line treatment is a thumb spica splint with a corticosteroid injection into the sheath; surgical release of the compartment cures the resistant case. ## What you must remember - **Anatomy of the entrapment:** the first dorsal compartment holds abductor pollicis longus (APL) and extensor pollicis brevis (EPB) under the extensor retinaculum near the radial styloid; the APL frequently travels as multiple slips, and a septum dividing the compartment is the common reason an injection or release seems to fail. - **The test:** Finkelstein manoeuvre — thumb flexed into the palm, fist closed over it, wrist pushed into ulnar deviation; sharp pain over the radial styloid is positive (closely related Eichhoff description). - **Who presents:** women 30-50, peripartum and lactating mothers lifting infants with an abducted thumb, and workers doing repetitive pinch plus wrist deviation. - **Separate intersection syndrome:** pain, swelling and audible crepitus 4-6 cm proximal to the radial styloid, where APL and EPB cross over ECRL and ECRB — a paratendinitis of the crossover bursa, not first-compartment stenosis; releasing De Quervain for this pain misses the target. - **Treatment ladder:** rest and a thumb spica splint; corticosteroid injected into the tendon sheath (single-injection success commonly quoted around 50-80 per cent, higher when placed within the sheath); open or needle release of the retinacular roof for failure or recurrence. - **Named risk of release:** branches of the radial sensory nerve cross the compartment — injury leaves distressing dysaesthesia over the thumb web, the commonest complication worth quoting. ## From complaint to cure A 32-year-old mother, four months postpartum and breastfeeding, reports three months of radial-sided wrist pain; she can no longer lift her baby from the cot. Examination shows tenderness and faint swelling over the radial styloid, a positive Finkelstein test, and — importantly — no tenderness 5 cm proximal, excluding intersection syndrome. The plan runs splint plus sheath injection: the needle enters at the radial styloid aimed distally along the sheath, and she is warned that depot steroid can depigment or thin the skin — a real counselling point in Indian practice. Breastfeeding is no barrier to local steroid. If pain persists at six to eight weeks, one repeat injection is reasonable; persistence beyond that or recurrence after two injections moves to release. Under local anaesthesia, a short incision over the compartment exposes the retinacular roof, the radial sensory branches are visualised and protected, every septum is divided until both tendons glide freely — including any extra APL slips — and immediate active thumb motion follows. Recurrence after a complete release is rare, and the mother lifts the baby again within days. ## How the exam frames it Three question shapes recur. The anatomy — which compartment (first dorsal), which tendons (APL and EPB), what anomalies complicate it (multiple APL slips, a septate compartment, an absent EPB). The bedside test — Finkelstein — where the examiner's trap is the technique: the thumb is folded into the fist and deviation is passive, not the active thumb-out manoeuvre students describe. The confusable — intersection syndrome, with the 4-6 cm proximal location and crepitus as the discriminating pair. In viva, pairing the lactating mother with De Quervain and the distance of intersection syndrome from the styloid is the sequence that scores. Indian outpatient reality adds clothes-wringing and atta-kneading to the history, and a day-care release when follow-up is uncertain. ## Frequently asked questions ### Which tendons are affected in De Quervain tenosynovitis? The abductor pollicis longus and extensor pollicis brevis, together in the first dorsal extensor compartment beneath the extensor retinaculum at the radial styloid. ### How is the Finkelstein test performed? The patient flexes the thumb into the palm and closes the fingers over it; the examiner passively deviates the wrist ulnar-ward, and reproduction of pain over the radial styloid is positive. ### How does intersection syndrome differ from De Quervain disease? Intersection syndrome causes pain and crepitus 4-6 cm proximal to the radial styloid where the first-compartment tendons cross the radial wrist extensors, whereas De Quervain pain sits at the styloid itself. ### What is first-line treatment after diagnosis? A thumb spica splint with a corticosteroid injection into the tendon sheath, reserving one repeat injection before considering surgical release. ### Which nerve is at risk during surgical release? The superficial branches of the radial nerve, which cross the first dorsal compartment and, if injured, cause painful dysaesthesia over the dorsum of the thumb web.