First Extensor Compartment Tenderness

Historical Overview

• The fist extensor compartment of the wrist contains the tendons of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL); tenderness in this region is indicative of tenosynovitis.
• This condition is generally referred to as de Quervain’s tenosynovitis. de Quervain first described the disease, as “stenosing tendovaginitis at the radial styloid process,” in 1895¹.

Description

• Tenderness at the first extensor compartment, around the radial styloid process
• Catching or triggering of the tendons may also be present

Pathophysiology

• Inflammation of the EPB/APL tendons and/or their synovial sheaths results in interference with, and thickening of, the fibrous sheath of the first extensor compartment. This causes pain and interferes with tendon function, sometimes resulting in catching or triggering of the tendons.

Instructions

1. Take patient history
2. Palpate the first extensor compartment at the radial styloid

Variations

• Eichoff: flexed thumb held in patient’s fist
• Finkelstein²: elicit pain by forcing the involved tendons against the radial styloid process
• Brunelli³: elicits pain by forcing the involved tendons against the pulley formed by the dorsal carpal ligament

Related Signs and Tests

• Grind test
• Second extensor compartment tenderness

Diagnostic Performance Characteristics

• As the involve structures are superficial, palpation of the first compartment is straightforward. Suspicion of de Quervain’s tenosynovitis can be confirmed by provocative testing.