De Quervain tenosynovitis
Background
- Tenosynovitis of abductor pollicis, extensor pollicis brevis (where tendons lie in groove of radial styloid)
Clinical Features
- Pain along radial aspect of wrist (may radiate to thumb or extend into the forearm)
- Finkelstein test is positive
- Pt grasps thumb in palm of the hand and ulnar deviates the thumb and hand
- This stretches the tendons over the radial styloid producing sharp pain
- Pt grasps thumb in palm of the hand and ulnar deviates the thumb and hand
Differential Diagnosis
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Diagnosis
Treatment
- Splint thumb and wrist
- Instruct pt to remove splint briefly each day to perform range-of-motion exercises
- NSAIDs x 10-14d
- Persistent cases may require steroid injection or surgical decompression
See Also
References
- Tintinalli
- Atlas of Emergency Medicine