Deep lipomas arising from the extensor compartments of the wrist are extremely rare. Owing to infrequent presentation and mass effect on nearby structures, lipomas can be mistaken for other clinical entities. We describe a 70-year-old woman who presented to our clinic with symptoms initially suggestive of de Quervain’s tenosynovitis of the left wrist. However, findings of physical examinations and imaging techniques revealed a lipoma of the tendon sheath of the second dorsal compartment. The patient was successfully treated operatively, with excision and release of the first dorsal compartment. To help accurately diagnosis and treat lipomas of the wrist in deep-tissue areas—with symptoms initially similar to de Quervain’s tenosynovitis—surgeons should consider performing thorough physical examinations and, if needed, magnetic resonance imaging.

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