Extensor triggering in de Quervain's stenosing tenosynovitis

Extensor triggering is an uncommon but recognized component of de Quervain's stenosing tenosynovitis. In a retrospective review of 827 patients with the diagnosis of de Quervain's disease over a 5-year period, 11 patients with 13 affected wrists were identified who had demonstrable triggering by both history and physical examination (prevalence of 1.3%). One wrist underwent surgical release without conservative treatment. The remaining 12 wrists were initially treated with nonoperative modalities. Failure of conservative treatment as defined by recurrent triggering and pain occurred in 7 wrists, of which 5 underwent surgical release. At the time of surgery, all wrists were noted to have synovitis, separate compartments for the extensor pollicis brevis and abductor pollicis longus tendons, and no intratendinous nodules. After an average follow-up period of 42 months (range, 5.7-94.5 months) there were no recurrences of triggering after surgical treatment. Seven of 12 wrists with triggering de Quervain's stenosing tenosynovitis failed nonoperative treatment. Triggering or locking in extension is an uncommon symptom in de Quervain's stenosing tenosynovitis and demonstrates a more recalcitrant course when treated nonoperatively.