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De Quervain's release

Surgeon-side topic for de quervain's release. Backed by 93 articles from the corpus, retrieved via combined MeSH + title-text matching.

Overview

De Quervain tenosynovitis involves constriction of the first dorsal compartment, with testosterone replacement therapy increasing both the likelihood of developing the condition and the need for surgical release [1]. While corticosteroid injection with short-term immobilization remains the primary effective treatment [20], surgical release is indicated for triggering, a rare presentation where most cases require intervention [2]. Patients presenting with low physical function scores (<40 on PROMIS) or high pain interference scores (>60 on PROMIS) demonstrate significantly increased odds of eventual surgical release [7].

Surgical options include simple release or Z-plasty of the retinaculum, both of which are effective [9], with endoscopic techniques offering earlier symptom relief, fewer superficial radial nerve complications, and greater scar satisfaction compared to traditional open release [6, 8]. Tendoscopic approaches also facilitate earlier recovery and more desirable scarring while maintaining equivalent long-term success rates to open techniques [6]. Although intracompartmental septa do not significantly alter outcomes or complications in endoscopic release [4], exploration of both compartments is advised when symptoms involve only the extensor pollicis brevis in a separate compartment [5].

Dissatisfaction following first dorsal compartment release may stem from incomplete release, tendon subluxation, nerve injury, or prolonged recovery duration [14]. In the context of distal radius fracture fixation, performing a first dorsal compartment release via a volar approach yields significantly greater short-term symptom reduction compared to no release [3].

Anatomy & Pathophysiology

Anatomical variations of the first dorsal compartment are frequent and act as predisposing cofactors for de Quervain disease, particularly under higher training loads [32, 34]. While dye dispersion into a single compartment containing both tendons occurs in 72% of wrists, a separate septum for the extensor pollicis brevis tendon exists in 28% [37]. Surgical release requires identifying all accessory compartments to ensure complete decompression [35].

Diagnostic Imaging: Radiographs are necessary to rule out other lesions in patients unresponsive to conservative management [11]. If diagnostic maneuvers produce pain outside the radial styloid, advanced imaging should be considered to identify other anatomic causes [15]. Ultrasonography provides reliable evaluation of first extensor compartment anatomy and improves needle placement accuracy for injections [31].

Neural Considerations: Knowledge of the superficial radial nerve course and its branches is critical during open release to avoid injury [29].

Etiology & Testing: Testosterone replacement therapy is associated with an increased likelihood of both de Quervain tenosynovitis and the subsequent need for surgical release [1]. The wrist hyperflexion and abduction of the thumb (WHAT) test is a more precise diagnostic tool than Eichhoff's test and can guide early clinical diagnosis [36].

Management Context: Tendinopathies of the hand and wrist are common, easily diagnosed, and managed straightforwardly with nonsurgical treatments (splinting, injection, therapy) or surgical release [30]. Steroid injection combined with splinting yields satisfactory outcomes in 62% of wrists at a mean of eighteen months [33]. Isometric thumb extension exercises are a safe and feasible intervention within a multimodal approach [40]. Ultrasound examination of the hand and wrist is evolving in indications, requiring physician training and knowledge of appropriate reimbursement codes [28].

Classification

Risk Factors: Testosterone replacement therapy is associated with an increased likelihood of de Quervain tenosynovitis [1]. Post-traumatic de Quervain's syndrome is very uncommon and often overlooked initially due to its rarity [10].

Surgical Indications: Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases [2]. Patients who scored lower than 40 for physical function or higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis [7]. In cases with symptoms of de Quervain's syndrome where the constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised [5].

Diagnostic Considerations: Radiographs of the wrist are necessary to rule out any other lesion resulting in wrist pain in patients not responding to conservative management of de Quervain's disease [11]. A patient apparently presenting with de Quervain's disease was classified as derangement syndrome using Mechanical Diagnosis and Therapy [16].

Clinical Presentation

De Quervain tenosynovitis presents with persistent radial wrist pain, which may follow trauma, though a definitive causative link between injury and the syndrome remains unproven [17]. While post-traumatic cases are uncommon and often initially overlooked [10], patients with lower physical function scores (<40) or higher pain interference scores (>60) on PROMIS measures demonstrate significantly increased odds of requiring surgical release [7]. Testosterone replacement therapy is also associated with an increased likelihood of developing the condition [1].

Diagnostic evaluation begins with physical maneuvers; the Finkelstein test can be performed in a staged version that is reliable, reproducible, and causes minimal discomfort compared to traditional descriptions [22]. If these maneuvers elicit pain outside the radial styloid, advanced imaging is required to identify alternative anatomic causes [15]. Radiographs are necessary to rule out other lesions in patients unresponsive to conservative management [11]. Additionally, patients may be classified as having a derangement syndrome using Mechanical Diagnosis and Therapy [16].

Addressing patient misconceptions regarding symptom duration and consequences facilitates informed treatment decisions [23]. Surgical intervention is indicated for rare triggering cases where release is typically required [2]. Intraoperative exploration of both compartments is advised when constriction involves only the extensor pollicis brevis within a separate compartment [5]. While release of the first dorsal compartment is effective, dissatisfaction may arise from incomplete release, tendon subluxation, nerve injury, or recovery duration [14].

Investigations

Plain radiography: Radiographs of the wrist are necessary to rule out other lesions resulting in wrist pain in patients not responding to conservative management of de Quervain's disease [11].

Other Considerations: Diagnostic maneuvers for de Quervain tenosynovitis that produce pain in a location other than the radial styloid indicate that advanced imaging should be considered to identify other anatomic causes for the pain [15]. Testosterone replacement therapy is associated with an increased likelihood of de Quervain tenosynovitis [1] and an increased likelihood of requiring surgical release for the condition [1]. Growth hormone abuse is associated with a more recalcitrant form of de Quervain tenosynovitis that does not respond well to nonsurgical treatment [26] and leads to an increased likelihood of surgical decompression [26]. Patients who scored lower than 40 for physical function on Patient-Reported Outcomes Measurement Information System measures had significantly increased odds of eventually undergoing surgical release [7], while patients who scored higher than 60 for pain interference on these measures also had significantly increased odds of eventual surgical release [7]. Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases [2]. Post-traumatic de Quervain's syndrome is very uncommon and often overlooked initially due to its rarity [10], though once diagnosed, it is typically successfully treated non-operatively [10]; clinicians should be aware that persistent radial wrist pain following injury may be due to de Quervain's syndrome [17]. A patient presenting with de Quervain's disease may be classified as derangement syndrome using Mechanical Diagnosis and Therapy [16]. Regarding surgical planning, the presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome [4]. In cases with symptoms of de Quervain's syndrome where the constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised [5]. When the extensor pollicis brevis tendon extends to the thumb interphalangeal joint, it is likely to reside in a subcompartment of the first dorsal compartment [24].

Treatment

Non-Operative

Corticosteroid injection is the preferred initial treatment for de Quervain's tenosynovitis and remains the only nonsurgical modality capable of potentially modifying the disease course [19]. When combined with a short duration of immobilization, corticosteroid injection serves as the primary and effective treatment [20]. Furthermore, the combined use of corticosteroid injection and hand therapy intervention decreases pain and symptomology in affected patients [13]. Post-traumatic de Quervain's syndrome, though rare and often initially overlooked, is typically successfully treated non-operatively once diagnosed [10].

Operative

Indications: Surgical release is indicated for patients with de Quervain tenosynovitis who scored lower than 40 for physical function or higher than 60 for pain interference, as these metrics are associated with significantly increased odds of eventual surgery [7]. Patients awaiting surgical decompression who exhibit more negative perceptions of the consequences of the disease or worse pain catastrophizing present with significantly worse baseline pain and reduced function [27]. Radiographs of the wrist are necessary to rule out other lesions resulting in wrist pain in patients who do not respond to conservative management [11]. Testosterone replacement therapy is associated with an increased likelihood of both developing de Quervain tenosynovitis and requiring surgical release [1]. Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases [2].

Surgical Approach / Technique: Both simple release and Z-plasty of the retinaculum are effective surgical methods for de Quervain's disease [9]. In cases where constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised [5]. The presence of an intracompartmental septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome [4]. Extensor retinaculum reconstruction using the wide-awake approach can be broadly applied without specialized equipment for optimizing function in de Quervain tenosynovitis [12].

Surgical Technique Comparison: Tendoscopic and open release techniques provide equivalent successful long-term outcomes for de Quervain's disease [6]. However, the tendoscopic technique provides earlier symptom relief and earlier recovery compared with the traditional open release technique [6]. Endoscopic release for de Quervain's tenosynovitis results in fewer superficial radial nerve complications compared with open release [8]. Additionally, endoscopic release results in greater scar satisfaction compared with open release [8]. First dorsal compartment release during a volar approach for distal radius fracture fixation results in a significantly greater reduction in de Quervain disease symptoms compared with no release during short-term follow-up [3].

Other Considerations: The scientific literature on the surgical and nonsurgical management of de Quervain tendinopathy is sparse and limited largely to uncontrolled cohorts with low-quality randomized trials [18].

Complications

Nerve palsy: Endoscopic release for de Quervain's syndrome is associated with fewer superficial radial nerve complications compared with open release [8]. The presence of an intracompartmental septum does not significantly affect complications following endoscopic release for de Quervain's syndrome [4].

Other Considerations: Surgical release is required in most cases of triggering due to de Quervain tenosynovitis [2]. Surgical release of the stenotic pulley or sheath for tendon disorders of the hand and wrist is associated with rare complications [42]. Testosterone replacement therapy is associated with an increased likelihood of requiring surgical release for de Quervain tenosynovitis [1]. Post-traumatic de Quervain's syndrome is often overlooked initially due to its rarity [10]. Regarding non-operative management, patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis compared to nondiabetic patients [38], and the success rate for the treatment of de Quervain's tenosynovitis decreases with multiple injections [39].

Recovery

Light activity (weeks): Patients may typically resume desk work, driving, and light activities of daily living following the procedure, though specific timelines vary by technique. Tendoscopic and endoscopic release methods facilitate earlier symptom relief and recovery compared with traditional open release techniques [6, 8].

Full activity (months): While endoscopic and open release techniques demonstrate equivalent successful long-term outcomes [6], the trajectory to full functional return differs by approach. Patients undergoing tendoscopic or endoscopic release experience earlier improvement after surgery compared with those receiving open release [6, 8].

Complete recovery / outcome plateau (months): Final functional outcomes stabilize once the surgical release is complete and complications are resolved. Dissatisfaction with the procedure can arise from incomplete release, tendon subluxation, nerve injury, or prolonged recovery duration [14].

Rehabilitation protocol: Post-traumatic de Quervain's syndrome is typically successfully treated non-operatively once diagnosed, often utilizing a combined approach of corticosteroid injection and hand therapy intervention to decrease pain and symptomology [10, 13]. For surgical cases, both simple release and Z-plasty of the retinaculum are effective surgical methods [9]. Extensor retinaculum reconstruction using the wide-awake approach can be broadly applied without specialized equipment for optimizing function [12].

Functional milestones: Preoperative patient selection is critical; patients with de Quervain tenosynovitis who scored lower than 40 for physical function or higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release [7]. The presence of an intracompartmental septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome [4].

Other Considerations: Surgical technique must account for anatomical variations; in cases where constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised [5]. Additionally, first dorsal compartment release during volar approach for distal radius fracture fixation significantly reduces de Quervain disease symptoms in the short-term follow-up compared with no release [3]. Endoscopic release results in fewer superficial radial nerve complications, fewer overall complications, and greater scar satisfaction compared with open release [6, 8].

Key Evidence

  • [L2] TRT is associated with an increased likelihood of both trigger finger and de Quervain tenosynovitis, and an increased likelihood of requiring surgical release for both conditions. (10.1016/j.jhsa.2024.01.018)
  • [L4] Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases. (10.1016/j.jhsg.2022.04.004)
  • [L1] The current results demonstrated a significantly greater reduction in de Quervain disease symptoms in the release group compared with the no release group during the short-term follow-up. (10.1016/j.jhsg.2024.03.009)
  • [L4] The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome. (10.1177/17531934231214137)
  • [L4] In cases with symptoms of de Quervain's syndrome where the constriction involves only the extensor pollicis brevis in a separate compartment, exploration of both compartments is advised. (10.2106/00004623-194931040-00019)
  • [L3] The results of this study suggest that tendoscopic technique for de Quervain's disease could provide earlier symptom relief and earlier recovery with fewer complications and more desirable scar, as well as equivalent successful long-term outcome, when compared with traditional open release technique. (10.1186/s13018-019-1393-5)
  • [L4] Patients who scored lower than 40 for physical function or higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis. (10.1016/j.jhsa.2023.07.005)
  • [L1] Endoscopic release for de Quervain's tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release. (10.1302/0301-620x.95b7.31486)
  • [L4] Both simple release and Z-plasty were effective surgical methods for de Quervain's disease. (10.1177/1753193418818341)
  • [L4] Post-traumatic de Quervain's syndrome is very uncommon and often overlooked initially due to its rarity, but once diagnosed is typically successfully treated non-operatively. (10.1177/1753193416646722)
  • [L4] Radiographs of the wrist are necessary to rule out any other lesion resulting in wrist pain in patients not responding to conservative management of de Quervain's disease. (10.1007/s11552-010-9258-8)
  • [L4] These procedures can be broadly applied without specialized equipment for optimizing function in de Quervain tenosynovitis. (10.1016/j.jhsa.2017.07.024)
  • [L1] The paper supports the combined use of corticosteroid injection and hand therapy intervention to decrease pain and symptomology as measured through provocative testing in patients with de Quervain's, though the strength of the evidence is limited. (10.1016/j.jht.2015.12.004)
  • [L4] Release of the first dorsal compartment is an effective treatment of de Quervain tendinopathy, though dissatisfaction can result from incomplete release, tendon subluxation, nerve injury, or recovery duration. (10.1016/j.jhsa.2015.09.003)
  • [L4] If diagnostic maneuvers for de Quervain tenosynovitis produce pain in a location other than the radial styloid, advanced imaging should be considered to identify other anatomic causes for the pain. (10.1016/j.jhsa.2014.09.024)
  • [L4] A patient apparently presenting with de Quervain's disease was classified as derangement syndrome using MDT. (10.1016/j.jht.2009.03.002)
  • [Letter] The letter argues that the original report failed to demonstrate a causative link between trauma and de Quervain's syndrome, suggesting clinicians should be aware that persistent radial wrist pain following injury may be due to de Quervain's syndrome. (10.1177/1753193417726668)
  • [L4] The scientific literature on the surgical and nonsurgical management of de Quervain tendinopathy is sparse and limited largely to uncontrolled cohorts with low-quality randomized trials. (10.1016/j.jhsa.2013.06.003)
  • [L4] According to the limited evidence available, injection of corticosteroids is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis and is therefore the preferred initial treatment. (10.1016/j.jhsa.2008.12.030)
  • [L1] Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis. (10.1016/j.jhsa.2024.03.003)
  • [L4] The authors describe a staged version of the Finkelstein test that is reliable, easy, and reproducible for diagnosing de Quervain's tendonitis while causing minimal discomfort compared to traditional descriptions. (10.1016/j.jhsa.2010.05.022)
  • [L3] Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values. (10.1097/corr.0000000000001577)
  • [L4] When it does, particularly in patients with de Quervain's disease, it is likely to reside in a subcompartment of the first dorsal compartment. (10.1016/j.jhsa.2008.12.015)
  • [L3] Our results suggest that growth hormone abuse is associated with a more recalcitrant form of de Quervain tenosynovitis that does not respond well to nonsurgical treatment, thus leading to increased likelihood of surgical decompression. (10.1177/0363546509337993)
  • [L3] More negative perceptions of the consequences of de Quervain's tenosynovitis and worse pain catastrophizing are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression of de Quervain's tenosynovitis. (10.1097/corr.0000000000000992)
  • [L5] Ultrasound examination of the hand and wrist is evolving in its indications and expanding in its use; physicians who use this study should be trained accordingly and gain knowledge regarding appropriate reimbursement codes. (10.1016/j.jhsa.2018.03.034)
  • [L5] Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury. (10.1016/j.jhsa.2013.12.004)
  • [L5] Tendinopathies involving the hand and wrist are common, often diagnosed easily, and managed straightforwardly with nonsurgical treatments such as splinting, injection, or therapy, or surgical techniques such as tendon release. (10.5435/jaaos-d-14-00216)
  • [L5] Ultrasonography consistently provided a reliable evaluation of the pertinent first extensor compartment anatomy and, in this cadaver model, improved the accuracy of needle placement for first extensor compartment injection. (10.5435/jaaos-d-15-00753)
  • [L4] The occurrence of variations in the insertion of the abductor pollicis longus tendon is more common and in greater number per forearm than has been generally realized. (10.2106/00004623-195133020-00007)
  • [L4] Anatomical variants act as predisposing cofactors that become more significant with higher training loads. (10.1177/0363546504268134)
  • [L5] In resistant cases, surgical release of the first dorsal compartment is done, taking care to protect the radial sensory nerve and identify all accessory compartments. (10.5435/00124635-200712000-00009)
  • [L2] The wrist hyperflexion and abduction of the thumb test is a more precise tool for the diagnosis of de Quervain's disease than the Eichhoff's test and could be adopted to guide clinical diagnosis in the early stages of de Quervain's tendinopathy. (10.1177/1753193412475043)
  • [L5] In 72% of wrists, dye dispersed into one compartment containing both tendons, but in 28% a separate septum existed for the EPB tendon. (10.1177/1753193411409126)
  • [L4] Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients, but the effectiveness of each additional injection does not appear to diminish. (10.1016/j.jhsa.2022.02.018)
  • [L2] Although the success rate for the treatment of De Quervain's tenosynovitis decreases with multiple injections, repeat injections have a high rate of success and are a viable clinical option. (10.1016/j.jhsa.2021.04.018)
  • [L2] Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain's syndrome. (10.1177/17589983231158499)
  • [L4] Surgical release of the stenotic pulley or sheath is curative in well over 90% of cases with rare complications and long-lasting relief. (10.1016/j.jhsa.2010.03.001)

See Also

References

[1] Testosterone Replacement Therapy and Associated Rates of Trigger Finger, de Quervain Tenosynovitis, and Their Subsequent Management. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.01.018

[2] Triggering Thumb Is Not Always a Trigger Thumb. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.04.004

[3] First Dorsal Compartment Release During Volar Approach for Distal Radius Fracture Fixation Reduces Symptoms in Patients With Pre-Existing De Quervain Disease. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.03.009

[4] Prediction of an intracompartmental septum and its effect on outcomes of endoscopic release for de Quervain’s syndrome. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231214137

[5] AN UNUSUAL FORM OF DE QUERVAINʼS SYNDROME. The Journal of Bone & Joint Surgery. 1949. DOI: 10.2106/00004623-194931040-00019

[6] Tendoscopic versus open release for de Quervain’s disease: earlier recovery with 7.21 year follow-up. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1393-5

[7] Association of Patient-Reported Outcomes Measurement Information System Measures With Injection and Surgical Treatment Response in Patients With De Quervain Tenosynovitis. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.07.005

[8] Endoscopicversusopen release in patients with de Quervain’s tenosynovitis. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b7.31486

[9] Comparison between simple release and Z-plasty of retinaculum for de Quervain’s disease: a retrospective study. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193418818341

[10] Post-traumatic de Quervain’s syndrome: a rare condition, often diagnosed late. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416646722

[11] Does Radial Styloid Abnormality in de Quervain's Disease Affect the Outcome of Management?. HAND. 2010. DOI: 10.1007/s11552-010-9258-8

[12] Extensor Retinaculum Reconstruction Using the Wide-Awake Approach. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.07.024

[13] Clinical Relevance Commentary on: Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: A systematic review and meta-analysis. Journal of Hand Therapy. 2016. DOI: 10.1016/j.jht.2015.12.004

[14] Dissatisfaction After First Dorsal Compartment Release for de Quervain Tendinopathy. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.09.003

[15] Longitudinal Split Tear of the Extensor Pollicis Brevis Tendon: Report of 2 Cases. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.09.024

[16] Application of Mechanical Diagnosis and Therapy to a Patient Diagnosed with de Quervain's Disease: A Case Study. Journal of Hand Therapy. 2009. DOI: 10.1016/j.jht.2009.03.002

[17] Letter and reply. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417726668

[18] Current Treatment of de Quervain Tendinopathy. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.06.003

[19] Nonsurgical Treatment for de Quervain's Tenosynovitis. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.030

[20] Advancements in de Quervain Tenosynovitis Management: A Comprehensive Network Meta-Analysis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.03.003

[22] Staged Description of the Finkelstein Test. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.05.022

[23] Are Patient Expectations and Illness Perception Associated with Patient-reported Outcomes from Surgical Decompression in de Quervain’s Tenosynovitis?. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001577

[24] Thumb Interphalangeal Joint Extension By the Extensor Pollicis Brevis: Association With a Subcompartment and de Quervain's Disease. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.015

[26] Abuse of Growth Hormone Increases the Risk of Persistent de Quervain Tenosynovitis. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509337993

[27] Which Psychological Variables Are Associated With Pain and Function Before Surgery for de Quervain’s Tenosynovitis? A Cross-sectional Study. Clinical Orthopaedics & Related Research. 2019. DOI: 10.1097/corr.0000000000000992

[28] Principles of Billing for Diagnostic Ultrasound in the Office and Operating Room. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.03.034

[29] The Relationship of the Superficial Radial Nerve and Its Branch to the Thumb to the First Extensor Compartment. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.12.004

[30] Tendinopathies of the Hand and Wrist. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00216

[31] Ultrasonography-guided de Quervain Injection. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-15-00753

[32] ANATOMICAL AND CLINICAL STUDY OF THE VARIATIONS IN THE INSERTIONS OF THE ABDUCTOR POLLICIS LONGUS TENDON, ASSOCIATED WITH STENOSING TENDOVAGINITIS. The Journal of Bone & Joint Surgery. 1951. DOI: 10.2106/00004623-195133020-00007

[33] Treatment of de Quervain tenosynovitis. A prospective study of the results of injection of steroids and immobilization in a splint.. The Journal of bone and joint surgery. American volume. 1991.

[34] De Quervain Disease in Volleyball Players. The American Journal of Sports Medicine. 2005. DOI: 10.1177/0363546504268134

[35] de Quervain Tenosynovitis of the Wrist. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200712000-00009

[36] The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193412475043

[37] Accuracy of intrasheath injection techniques for de Quervain’s disease: a cadaveric study. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193411409126

[38] Effectiveness of Corticosteroid Injections in Diabetic Patients With De Quervain Tenosynovitis. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.02.018

[39] De Quervain Tenosynovitis: An Evaluation of the Epidemiology and Utility of Multiple Injections Using a National Database. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.04.018

[40] Isometric thumb extension exercise as part of a multimodal intervention for de Quervain’s syndrome: A randomised feasibility trial. Hand Therapy. 2023. DOI: 10.1177/17589983231158499

[42] Tendon Disorders of the Hand and Wrist. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.03.001

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c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.