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Age / Sex : 28 / F
Age / Sex : 24/F
Chief complaint : Wrist pain
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
* Send Application Answers to Ja-Young Choi, MD (drchoi01@gmail.com)
Courtesy : Mi Sook Sung, MD. The Catholic University of Korea, Holy Family Hospital
Diagnosis: de Quervain's disease
Discussion
Findings:
Increased thickness of the extensor pollicus brevis and abductor pollicis longus tendons with peritendinous edema and contrast enhancement after injection of the contrast media can be seen on axial MR images.
Differential Diagnosis:
Tenosynovitis including tuberculous origin
Diagnosis: de Quervain's disease.
Discussion:
• Fritz de Quervain first described stenosing tenosynovitis of the 1st dorsal extensor compartment of the wrist in 1895.
• most often idiopathic
• associated with occupations including home duties, secretarial work, nursing
• associated with overuse injury, trauma, and pregnancy
• F (X10) > M
• Finkelstein’s test (+)
• Increased extensor pollicus brevis and abductor pollicis longus tendon thickness and peritendinous edema are the most reliable imaging findings on MRI.
• Surrounding subcutaneous edema and increased intratendinous signal were less reliable findings
References:
1. Moore JS. De Quervain's tenosynovitis. Stenosing tenosynovitis of the first dorsal compartment. J Occup Environ Med. 1997 Oct;39(10):990-1002. Review.
2. Glajchen N, Schweitzer M. MRI features in de Quervain's tenosynovitis of the wrist. Skeletal Radiol. 1996 Jan;25(1):63-5.
3. Chen WS, Eng HL. Tuberculous tenosynovitis of the wrist mimicking de Quervain's disease. J Rheumatol. 1994 Apr;21(4):763-5.
4. Giovagnorio F, Andreoli C, De Cicco ML. Ultrasonographic evaluation of de Quervain disease. J Ultrasound Med. 1997 Oct;16(10):685-9.
5. Alberton GM, High WA, Shin AY, Bishop AT. Extensor triggering in de Quervain's stenosing tenosynovitis. J Hand Surg [Am]. 1999 Nov;24(6):1311-4.
6: Nagaoka M, Matsuzaki H, Suzuki T. Ultrasonographic examination of de Quervain's disease. J Orthop Sci. 2000;5(2):96-9.
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