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Greenslopes Private Hospital Greenslopes, QLD 4120 Australia
I read with great interest the article entitled "Focal Radial Styloid Abnormality as a Manifestation of de Quervain Tenosynovitis," by Chien et al. [1]. In the title and the objective, the authors refer to the abnormality as de Quervain tenosynovitis, but at the beginning of the objective, they state that de Quervain disease is a stenosing tenosynovitis of the first dorsal wrist compartment. De Quervain originally described the entity that now bears his name as a tenovaginitis, thickening of the fibrous sheath of the first extensor compartment—that is, thickening of part of the extensor retinaculum [2]. Marked thickening of the tendon sheath due to proliferation of fibrous tissue may be an associated finding, but the original description was not of a primary tenosynovitis. In later years, tenosynovitis involving the first extensor compartment has come to be labeled "de Quervain tenosynovitis," but this is semantically different from de Quervain disease [3]. It would be interesting to know whether the patients in the published study could be identified as having clinical de Quervain disease or de Quervain tenosynovitis and whether this distinction was confirmed by imaging or surgery.
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University of Michigan, Medical Center, Ann Arbor, MI 48109-0326
We thank Dr. Daunt for his comments pertaining to our article [1]. Although his letter describes a distinction between de Quervain disease and de Quervain tenosynovitis, we found in our literature search significant overlap with regard to the use of these terms. The most common description from various medical specialties was "de Quervain disease is a stenosing tenosynovitis." In fact, one article [2] quoted the original work from 1895 and described the original cases as "stenosing tenovaginitis that arose from a thickening of the common tendon sheath of the abductor pollicis longus and extensor pollicis brevis tendons."
Perhaps thickening of the fibrous sheath of the first wrist compartment and thickening of the tendon sheath may be difficult to differentiate. It is conceivable that these findings could represent different aspects or early and late stages of the same pathologic process. In our study [1], the symptomatic subjects were diagnosed by physical examination (positive results on Finkelstein's test), and this distinction could not be made. We thank Daunt for bringing this difference between de Quervain disease and de Quervain tenosynovitis to our attention.
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