Skip to content

Patients › Wrist

德奎尔万腱鞘炎

PDF Evidence

Patient-facing topic on De Quervain's tenosynovitis (first dorsal compartment) — diagnosis, conservative management, and indications for de Quervain's release.

Updated May 2026
一幅手绘插图，描绘了一位无面的家长抱着婴儿，手腕拇指侧出现疼痛。
受De Quervain病影响的拇指肌腱解剖——桡侧腕长伸肌和桡侧腕短伸肌在穿过腕部时的结构。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会感到手腕拇指侧疼痛。该区域称为桡骨茎突。疼痛通常在受伤后开始，或随时间逐渐发展。您可能会发现，在进行日常手部活动后疼痛会加剧。简单的动作，如伸手到背后扣内衣或塞衬衫下摆，可能会变得困难。

您的症状在抓握物品或提举物体时可能会感觉更严重。许多患者报告称，活动后疼痛会加重，并可能持续到夜间。有些人发现难以侧卧于患侧手臂睡觉。怀孕是已知的危险因素，会增加您出现这些症状的可能性。如果您患有糖尿病，您可能会发现单一治疗对您的效果不如对其他人有效。

有时疼痛不仅限于手腕，而是感觉来自拇指本身。您可能会在拇指中体验到卡压或弹响的感觉。这是由于腱鞘发炎所致。虽然大多数病例首先采用非手术治疗，但持续性疼痛可能导致手术。如果您的疼痛没有改善，您的外科医生将讨论最适合您具体需求的最佳治疗方案。

实际发生了什么

您的拇指在被称为第一伸肌间隔的狭窄通道内进出运动。在这个通道内，一根绳索状的肌腱来回滑动。正常情况下，这种滑动是平滑的。在德奎尔万腱鞘炎中，该肌腱周围的滑膜变得肿胀和发炎。可以将其想象为一根绳索在狭窄的套筒内磨损。肿胀使得空间变得过于狭小，因此当您移动拇指时，肌腱会与通道侧壁发生摩擦。这种摩擦会导致您在拇指根部感到剧烈疼痛。

有时，附近的其他结构也可能引起类似的疼痛。一块名为桡侧腕屈肌短头的额外肌肉可能会造成阻碍并受到刺激。如果您的疼痛并非正好位于拇指根部，或者您的拇指关节感觉僵硬，则可能存在其他原因。您的外科医生可能会使用超声或 MRI 仔细检查这些组织。这些工具有助于找到您疼痛的确切来源，从而使治疗方案与问题相匹配。

这种情况通常首先采用非手术治疗。向通道内注射皮质类固醇可以减轻肿胀并改变肌腱的运动方式。这种治疗在两次注射内的成功率约为 73.4%。然而，如果您患有糖尿病，单次注射的成功率可能会降低。如果肿胀不消退，肌腱可能会卡住或出现扳机指现象，这通常需要通过手术松解来修复。

我们能采取的措施

大多数人从自我护理和物理治疗开始。您的外科医生可能会建议您让拇指和手腕休息，以减轻肿胀。您可以尝试使用拇指人字石膏或夹板，以限制运动，促进肌腱愈合。物理治疗旨在温和地拉伸和加强该区域，同时不引起更多疼痛。如果您患有糖尿病，您应该知道，与其他人相比，单次注射对您来说效果较差，但多次注射仍然有效。许多患者在尝试更具侵入性的方法之前，通过这些非手术步骤找到了缓解。

如果简单的休息没有帮助，您的外科医生可能会推荐皮质类固醇注射。这是唯一可以改变您病情进程的非手术治疗。它通过减少肌腱鞘内的炎症来发挥作用。一次或两次注射的成功率为 73.4%。在某些情况下，单次注射可使 82% 的患者受益，其中超过一半的患者症状至少持续 12 个月无复发。虽然效果可以持续很长时间，但如果需要多次注射，治疗的成功率会下降。其他选项，如超声波或离子导入法，也可能有助于减轻疼痛并改善功能。

当保守治疗达到极限或症状持续存在时，就会考虑手术。如果尽管进行了注射和休息，疼痛仍然严重，您的外科医生会与您讨论这一点。手术涉及释放肌腱周围紧绷的组织，使其能够自由滑动。这通常仅用于非手术方法未能提供持久缓解的情况。

何时就诊

若拇指侧腕部持续性疼痛经休息后无改善，请就诊全科医生。若发现拇指出现卡顿或无力症状，请要求专科医生评估。若症状干扰睡眠或工作，或疼痛突然加重，也应寻求医疗帮助。若疼痛部位不在拇指骨附近的典型位置，可能需要高级影像学检查以排除其他病因。虽然大多数病例首选非手术治疗（如类固醇注射，两次注射内有效率达73.4%），但若症状持续，部分患者可能需要手术治疗。

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Overview

  • Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases [1].
  • Patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [2].
  • 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 [3].
  • 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 [4].
  • Extensor retinaculum reconstruction procedures can be broadly applied without specialized equipment for optimizing function in de Quervain tenosynovitis [5].
  • Corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections [11].
  • Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients [12].
  • The effectiveness of each additional corticosteroid injection for de Quervain tenosynovitis in diabetic patients does not appear to diminish [12].
  • Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis [13].
  • The success rate for the treatment of De Quervain's tenosynovitis decreases with multiple injections [15].
  • Repeat injections for De Quervain's tenosynovitis have a high rate of success and are a viable clinical option [15].
  • 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 [16].
  • Endoscopic release for de Quervain's tenosynovitis seems to provide earlier improvement after surgery compared with open release [21].
  • Endoscopic release for de Quervain's tenosynovitis results in fewer superficial radial nerve complications compared with open release [21].
  • Endoscopic release for de Quervain's tenosynovitis results in greater scar satisfaction compared with open release [21].
  • Patients who scored lower than 40 for physical function had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis [26].
  • Patients who scored higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis [26].

Anatomy & Pathophysiology

  • Extensor retinaculum reconstruction can be broadly applied without specialized equipment for optimizing function in de Quervain tenosynovitis [5].
  • Diagnostic maneuvers for de Quervain tenosynovitis that produce pain in a location other than the radial styloid suggest the need for advanced imaging to identify other anatomic causes [6].
  • The tethered thumb maneuver elicits a characteristic response in many patients with de Quervain tenosynovitis [10].
  • The tethered thumb maneuver can support the diagnosis of de Quervain tenosynovitis [10].
  • The tethered thumb maneuver can assist in determining an effective treatment algorithm for de Quervain tenosynovitis [10].
  • MRI is the imaging modality with the greatest ability to visualize the vast number of pathological conditions that can cause pain in the upper extremity [27].
  • Stiffness of the proximal interphalangeal joints secondary to tenosynovitis is rare [28].
  • Screw penetration greater than 1.5 mm in the third and fourth extensor compartments is likely to cause problems [45].
  • The flexor carpi radialis brevis muscle can become clinically symptomatic when its tendon intersects with the flexor carpi radialis tendon [47].
  • Intersection of the flexor carpi radialis brevis tendon with the flexor carpi radialis tendon can cause localized tendinosis and tenosynovitis [47].
  • Anomalous muscles such as the flexor carpi radialis brevis should be included in the differential diagnosis of radial side wrist pain [50].
  • Extensor indicis proprius syndrome is characterized by dorsal wrist pain [51].
  • Extensor indicis proprius syndrome is characterized by synovitis within the fourth dorsal compartment [51].
  • In distal radial fractures treated with volar locking plates, ultrasonography can determine increases in the thickness of the flexor pollicis longus (FPL) tendon [53].
  • In distal radial fractures treated with volar locking plates, ultrasonography can determine a consequent decrease in the distance between the FPL tendon and the plate [53].
  • Ultrasonography consistently provided a reliable evaluation of the pertinent first extensor compartment anatomy in a cadaver model [55].
  • In a cadaver model, ultrasonography improved the accuracy of needle placement for first extensor compartment injection [55].
  • The short axis is more accurate than the long axis for ultrasound measurements of the first extensor compartment [56].

Classification

  • Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases [1].
  • Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [2].
  • 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 [3].
  • 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 [4].
  • Procedures such as extensor retinaculum reconstruction can be broadly applied without specialized equipment for optimizing function in de Quervain tenosynovitis [5].
  • 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 [6].
  • De Quervain's syndrome in a proportion of patients could be secondary to underlying wrist pathology due to previous trauma [7].
  • 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 [8].
  • Styloid abnormalities, though considered as a manifestation of de Quervain's disease by some authors, do not affect the outcome of management [9].
  • The proposed tethered thumb maneuver elicits a characteristic response in many patients with de Quervain tenosynovitis and can support the diagnosis and assist in determining an effective treatment algorithm [10].
  • 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 [17].
  • Septation of the first extensor compartment is more common in patients with de Quervain disease than in the general population, suggesting this anatomical variation may play an etiological role [25].
  • The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients with De Quervain tenosynovitis [33].
  • Quality information about De Quervain's tendinitis is available on the internet and is most likely to be found using the search term De Quervain's tenosynovitis and in the first 10 results of an internet search [37].

Clinical Presentation

  • Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases [1].
  • Patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [2].
  • Injection of corticosteroids is the only available nonsurgical treatment that can potentially modify the course of de Quervain's tenosynovitis [3].
  • 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 [4].
  • Procedures for extensor retinaculum reconstruction can be broadly applied without specialized equipment for optimizing function in de Quervain tenosynovitis [5].
  • 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 [6].
  • De Quervain's syndrome in a proportion of patients could be secondary to underlying wrist pathology due to previous trauma [7].
  • Post-traumatic de Quervain's syndrome is very uncommon and often overlooked initially due to its rarity [8].
  • Once diagnosed, post-traumatic de Quervain's syndrome is typically successfully treated non-operatively [8].
  • Styloid abnormalities do not affect the outcome of management in de Quervain's disease [9].
  • The proposed tethered thumb maneuver elicits a characteristic response in many patients with de Quervain tenosynovitis and can support the diagnosis and assist in determining an effective treatment algorithm [10].
  • Corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections [11].
  • 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 [14].
  • 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 [17].
  • No relationship was established between rheumatoid tenosynovitis and de Quervain's disease or snapping-finger [18].
  • The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome [19].
  • Clinicians should be aware that persistent radial wrist pain following injury may be due to de Quervain's syndrome [20].
  • Pregnancy is a significant risk factor for hand conditions and was associated with increased odds of de Quervain tenosynovitis [23].
  • The combined use of corticosteroid injection and hand therapy intervention decreases pain and symptomology as measured through provocative testing in patients with de Quervain's [30].
  • The strength of the evidence supporting the combined use of corticosteroid injection and hand therapy intervention is limited [30].
  • A staged version of the Finkelstein test is reliable, easy, and reproducible for diagnosing de Quervain's tendonitis while causing minimal discomfort compared to traditional descriptions [31].

Investigations

  • Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases [1].
  • Patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [2].
  • 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 [3].
  • 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 [4].
  • 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 [6].
  • De Quervain's syndrome in a proportion of patients could be secondary to underlying wrist pathology due to previous trauma [7].
  • 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 [8].
  • Styloid abnormalities do not affect the outcome of management in de Quervain's disease [9].
  • The proposed tethered thumb maneuver elicits a characteristic response in many patients with de Quervain tenosynovitis and can support the diagnosis and assist in determining an effective treatment algorithm [10].
  • 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 [17].
  • No relationship was established between rheumatoid tenosynovitis and de Quervain's disease or snapping-finger [18].
  • The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome [19].
  • Clinicians should be aware that persistent radial wrist pain following injury may be due to de Quervain's syndrome, as a causative link between trauma and the syndrome was not demonstrated in the original report [20].
  • Pregnancy is a significant risk factor for hand conditions and was associated with increased odds of de Quervain tenosynovitis [23].
  • Septation of the first extensor compartment is more common in patients with de Quervain disease than in the general population, suggesting this anatomical variation may play an etiological role [25].
  • No other imaging modality can compete with MRI's ability to visualize the vast number of pathological conditions that can cause pain in the upper extremity [27].
  • 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 [42].
  • Tenosynovitis with psammomatous calcification must be differentiated from intra-articular lesions, particularly in atypical presentations [43].

Treatment

  • Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases [1].
  • Patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [2].
  • 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 [3].
  • 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 [4].
  • Extensor retinaculum reconstruction using the wide-awake approach can be broadly applied without specialized equipment for optimizing function in de Quervain tenosynovitis [5].
  • 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 [8].
  • Styloid abnormalities do not affect the outcome of management in de Quervain's disease [9].
  • Corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections [11].
  • 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 [12].
  • Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis [13].
  • 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 [14].
  • 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 [15].
  • 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 [16].
  • 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 [21].
  • One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners leads to improvement in the short term in participants with de Quervain's tenosynovitis when compared to placebo [22].
  • Nonoperative options are commonly used as first-line treatment for tenosynovitis of the hand and wrist, but questions remain regarding when to advance to operative intervention [24].
  • A single cortisone injection was effective in alleviating symptoms of de Quervain tendinopathy in 82% of patients, with over half remaining symptom-free for at least 12 months [32].
  • The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes [34].
  • Iontophoresis with dexamethasone may improve functional outcomes in patients with de Quervain's tenosynovitis [35].
  • Therapeutic pulsed ultrasound may be effective in decreasing pain in patients with de Quervain's tenosynovitis [36].
  • First dorsal compartment release during volar approach for distal radius fracture fixation reduces symptoms in patients with pre-existing De Quervain disease [38].

Complications

  • Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases [1].
  • Patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [2].
  • 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 [3].
  • 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 [4].
  • 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 [6].
  • De Quervain's syndrome in a proportion of patients could be secondary to underlying wrist pathology due to previous trauma [7].
  • 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 [8].
  • Styloid abnormalities do not affect the outcome of management in de Quervain's disease [9].
  • Corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections [11].
  • Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients [12].
  • The effectiveness of each additional corticosteroid injection for de Quervain tenosynovitis in diabetic patients does not appear to diminish [12].
  • Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis [13].
  • 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 [14].
  • No relationship was established between rheumatoid tenosynovitis and de Quervain's disease or snapping-finger [18].
  • The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome [19].
  • Clinicians should be aware that persistent radial wrist pain following injury may be due to de Quervain's syndrome [20].
  • One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners leads to improvement in the short term in participants with de Quervain's tenosynovitis when compared to placebo [22].
  • Neither heavy manual labor nor trauma could be shown to be predisposing risk factors for de Quervain's tenosynovitis [39].
  • Risk factors for de Quervain's include female gender, age greater than 40, and black race [40].

Recovery

  • Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases [1].
  • Patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management [2].
  • 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 [3].
  • 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 [4].
  • De Quervain's syndrome in a proportion of patients could be secondary to underlying wrist pathology due to previous trauma [7].
  • The proposed tethered thumb maneuver elicits a characteristic response in many patients with de Quervain tenosynovitis and can support the diagnosis and assist in determining an effective treatment algorithm [10].
  • Corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections [11].
  • Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients [12].
  • The effectiveness of each additional corticosteroid injection for de Quervain tenosynovitis in diabetic patients does not appear to diminish [12].
  • Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis [13].
  • 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 [14].
  • 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 [15].
  • 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 [16].
  • 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 [21].
  • 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 [26].
  • Stiffness of the proximal interphalangeal joints secondary to tenosynovitis is rare [28].
  • The 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 [41].
  • Only 34.9% of patients with new stenosing tenosynovitis required surgery within a 2-year follow-up period [44].
  • Most patients with new stenosing tenosynovitis progress to surgery within 1 year of presentation [44].

Key Evidence

  • [L4] Triggering due to de Quervain tenosynovitis is a rare condition where surgical release is required in most cases. [1] (10.1016/j.jhsg.2022.04.004)
  • [L4] Providers should remain cognizant that patients presenting with de Quervain's tenosynovitis may favor initial nonsurgical management. [2] (10.1016/j.jhsg.2024.01.009)
  • [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. [3] (10.1016/j.jhsa.2008.12.030)
  • [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. [4] (10.1097/corr.0000000000001577)
  • [L4] These procedures can be broadly applied without specialized equipment for optimizing function in de Quervain tenosynovitis. [5] (10.1016/j.jhsa.2017.07.024)
  • [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. [6] (10.1016/j.jhsa.2014.09.024)
  • [L4] The results suggest that de Quervain's syndrome in a proportion of patients could be secondary to underlying wrist pathology due to previous trauma. [7] (10.1177/1758998315599796)
  • [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. [8] (10.1177/1753193416646722)
  • [L4] Though considered as a manifestation of de Quervain's disease by some authors, styloid abnormalities do not affect the outcome of management as proved in this study. [9] (10.1007/s11552-010-9258-8)
  • [L4] The proposed tethered thumb maneuver elicits a characteristic response in many patients with de Quervain tenosynovitis and can support the diagnosis and assist in determining an effective treatment algorithm. [10] (10.1016/j.jhsa.2013.04.017)
  • [L3] This study indicates that corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections. [11] (10.1177/1558944716681976)
  • [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. [12] (10.1016/j.jhsa.2022.02.018)
  • [L1] Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis. [13] (10.1016/j.jhsa.2024.03.003)
  • [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. [14] (10.1097/corr.0000000000000992)
  • [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. [15] (10.1016/j.jhsa.2021.04.018)
  • [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. [16] (10.1016/j.jhsa.2013.06.003)
  • [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. [17] (10.2106/00004623-194931040-00019)
  • [L4] The presence of a septum does not significantly affect clinical outcomes or complications following endoscopic release for de Quervain's syndrome. [19] (10.1177/17531934231214137)
  • [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. [20] (10.1177/1753193417726668)
  • [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. [21] (10.1302/0301-620x.95b7.31486)
  • [L1] One or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners leads to improvement in the short term in participants with de Quervain's tenosynovitis when compared to placebo. [22] (10.1186/1471-2474-10-131)
  • [L3] Pregnancy is a significant risk factor for hand conditions and was associated with increased odds of de Quervain tenosynovitis. [23] (10.1016/j.jhsg.2025.100778)
  • [L4] Nonoperative options are commonly used as first-line treatment for tenosynovitis of the hand and wrist, but questions remain regarding when to advance to operative intervention. [24] (10.2106/jbjs.rvw.o.00061)
  • [L4] Septation of the first extensor compartment is more common in patients with de Quervain disease than in the general population, suggesting this anatomical variation may play an etiological role. [25] (10.2106/00004623-198668060-00016)
  • [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. [26] (10.1016/j.jhsa.2023.07.005)
  • [L4] No other imaging modality can compete with MRI's ability to visualize the vast number of pathological conditions that can cause pain in the upper extremity. [27] (10.1197/j.jht.2007.04.001)
  • [L4] Stiffness of the proximal interphalangeal joints secondary to tenosynovitis is rare. [28] (10.2106/00004623-197658060-00010)
  • [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. [30] (10.1016/j.jht.2015.12.004)
  • [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. [31] (10.1016/j.jhsa.2010.05.022)
  • [L4] A single cortisone injection was effective in alleviating symptoms of de Quervain tendinopathy in 82% of patients, with over half remaining symptom-free for at least 12 months. [32] (10.1016/j.jhsa.2014.12.027)
  • [L3] The prevalence of a septated first dorsal compartment is considerably higher than previously reported, most notably in patients with De Quervain tenosynovitis. [33] (10.1177/1558944718810864)
  • [L2] The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes. [34] (10.1016/j.jhsa.2013.10.013)
  • [L4] This study demonstrated that iontophoresis with dexamethasone may improve functional outcomes, while therapeutic pulsed ultrasound may be effective in decreasing pain in patients with de Quervain's tenosynovitis. [35] (10.1016/j.jht.2014.08.033)
  • [L4] This study demonstrated that iontophoresis with dexamethasone may improve functional outcomes, while therapeutic pulsed ultrasound may be effective in decreasing pain in patients with de Quervain's tenosynovitis. [36] (10.1016/j.jht.2014.08.032)
  • [L4] Quality information about De Quervain's tendinitis is available on the internet and is most likely to be found using the search term De Quervain's tenosynovitis and in the first 10 results of an internet search. [37] (10.1007/s11552-014-9657-3)
  • [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. [38] (10.1016/j.jhsg.2024.03.009)
  • [L3] Neither heavy manual labor nor trauma could be shown to be predisposing risk factors for de Quervain's tenosynovitis. [39] (10.1186/s12891-015-0579-1)
  • [L2] Risk factors for de Quervain's in our population include female gender, age greater than 40, and black race. [40] (10.1016/j.jhsa.2008.08.020)
  • [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. [41] (10.1186/s13018-019-1393-5)
  • [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. [42] (10.1177/0363546509337993)
  • [Case_report] This case highlights the importance of differentiating tenosynovitis with psammomatous calcification from intra-articular lesions, particularly in atypical presentations, and demonstrates the effectiveness of surgical intervention in resolving symptoms. [43] (10.1016/j.jhsg.2023.08.001)
  • [L2] Only 34.9% of patients with new stenosing tenosynovitis required surgery within a 2-year follow-up period, with most progressing to surgery within 1 year of presentation. [44] (10.1016/j.jhsa.2017.06.088)
  • [L4] The study suggests that screw penetration greater than 1.5 mm in the third and fourth extensor compartments is likely to cause problems. [45] (10.1177/1753193410392869)
  • [Case_report] The flexor carpi radialis brevis muscle can become clinically symptomatic when its tendon intersects with the flexor carpi radialis tendon, causing localized tendinosis and tenosynovitis. [47] (10.1016/j.jhsa.2008.06.014)
  • [Case_report] Anomalous muscles such as the flexor carpi radialis brevis should be included in the differential diagnosis of radial side wrist pain. [50] (10.1016/j.jhsa.2009.12.028)
  • [L4] The extensor indicis proprius syndrome is characterized by dorsal wrist pain and synovitis within the fourth dorsal compartment. [51] (10.2106/00004623-196951080-00016)
  • [L4] In distal radial fractures treated with volar locking plates, increases in the thickness of the FPL tendon and a consequent decrease in the distance between the tendon and the plate can be determined with ultrasonography. [53] (10.1016/j.jhsa.2015.11.022)
  • [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. [55] (10.5435/jaaos-d-15-00753)
  • [L5] The results support the idea that the short axis is more accurate than the long axis. [56] (10.1177/1558944719873435)

References

[1] Triggering Thumb Is Not Always a Trigger Thumb. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.04.004 [2] De Quervain’s Tenosynovitis: As Seen from the Perspective of the Patient. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.01.009 [3] Nonsurgical Treatment for de Quervain's Tenosynovitis. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.030 [4] 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 [5] Extensor Retinaculum Reconstruction Using the Wide-Awake Approach. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.07.024 [6] 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 [7] De Quervain’s syndrome: It may not be an isolated pathology. Hand Therapy. 2015. DOI: 10.1177/1758998315599796 [8] Post-traumatic de Quervain’s syndrome: a rare condition, often diagnosed late. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416646722 [9] Does Radial Styloid Abnormality in de Quervain's Disease Affect the Outcome of Management?. HAND. 2010. DOI: 10.1007/s11552-010-9258-8 [10] Tethered Thumb Sign: A Unique Observation in the Physical Examination of de Quervain Tenosynovitis. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.04.017 [11] Effectiveness of Corticosteroid Injections for Treatment of de Quervain’s Tenosynovitis. HAND. 2016. DOI: 10.1177/1558944716681976 [12] 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 [13] 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 [14] 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 [15] 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 [16] Current Treatment of de Quervain Tendinopathy. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.06.003 [17] AN UNUSUAL FORM OF DE QUERVAINʼS SYNDROME. The Journal of Bone & Joint Surgery. 1949. DOI: 10.2106/00004623-194931040-00019 [18] Rheumatoid Tenosynovitis: Diagnosis and Treatment.. The Journal of Bone and Joint Surgery. American Volume. 1958. [19] 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 [20] Letter and reply. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417726668 [21] Endoscopicversusopen release in patients with de Quervain’s tenosynovitis. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b7.31486 [22] Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice. BMC Musculoskeletal Disorders. 2009. DOI: 10.1186/1471-2474-10-131 [23] Incidence and Risk Factors for Soft Tissue Hand and Wrist Conditions in Pregnancy and Postpartum. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100778 [24] Tenosynovitis of the Hand and Wrist. JBJS Reviews. 2016. DOI: 10.2106/jbjs.rvw.o.00061 [25] Anatomical variations in the first extensor compartment of the wrist. A clinical and anatomical study.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668060-00016 [26] 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 [27] Case Studies in the Diagnosis of Upper Extremity Pain Using Magnetic Resonance Imaging. Journal of Hand Therapy. 2007. DOI: 10.1197/j.jht.2007.04.001 [28] Stiffness of the proximal interphalangeal joints in rheumatoid arthritis. The role of flexor tenosynovitis. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658060-00010 [30] 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 [31] Staged Description of the Finkelstein Test. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.05.022 [32] de Quervain Tendinopathy: Survivorship and Prognostic Indicators of Recurrence Following A Single Corticosteroid Injection. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.027 [33] Prevalence of a Septated First Dorsal Compartment Among Patients With and Without De Quervain Tenosynovitis: An In Vivo Anatomical Study. HAND. 2018. DOI: 10.1177/1558944718810864 [34] Corticosteroid Injection With or Without Thumb Spica Cast for de Quervain Tenosynovitis. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.10.013 [35] The Upper Limb Functional Index (ULFI) – A Review of Published Validation Studies Show Improved Clinimetric Properties and Recommends a Simple Format Change. Journal of Hand Therapy. 2016. DOI: 10.1016/j.jht.2014.08.033 [36] Effective Conservative Treatments for De Quervain's Tenosynovitis: A Retrospective Study. Journal of Hand Therapy. 2016. DOI: 10.1016/j.jht.2014.08.032 [37] The Internet as a Source of Information for De Quervain's Tendinitis. HAND. 2014. DOI: 10.1007/s11552-014-9657-3 [38] 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 [39] Work related etiology of de Quervain’s tenosynovitis: a case-control study with prospectively collected data. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0579-1 [40] Incidence of de Quervain's Tenosynovitis in a Young, Active Population. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.08.020 [41] 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 [42] Abuse of Growth Hormone Increases the Risk of Persistent de Quervain Tenosynovitis. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509337993 [43] Tenosynovitis With Psammomatous Calcification Preoperatively Diagnosed as Intra-Articular Free Body of the Young Male Wrist: A Case Report. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.08.001 [44] A Prospective Study of Risk Modeling for Stenosing Tenosynovitis. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.088 [45] Screw prominences related to palmar locking plating of distal radius. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193410392869 [47] Flexor Carpi Radialis Brevis Muscle Presenting as a Painful Forearm Mass: Case Report. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.06.014 [50] Symptomatic Flexor Carpi Radialis Brevis: Case Report. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.12.028 [51] The Extensor Indicis Proprius Syndrome. The Journal of Bone & Joint Surgery. 1969. DOI: 10.2106/00004623-196951080-00016 [53] Ultrasonic Evaluation of the Flexor Pollicis Longus Tendon Following Volar Plate Fixation for Distal Radius Fractures. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.11.022 [55] Ultrasonography-guided de Quervain Injection. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-15-00753 [56] Ultrasound Measurements of the First Extensor Compartment: Determining the Transection Limits for Ultra-minimally Invasive Release of De Quervain Tenosynovitis. HAND. 2019. DOI: 10.1177/1558944719873435

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

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.