[22] De Quevain's Tenosynovitis Flashcards
What is De Quervain’s tenosynovitis?
Inflammation of the tendons within the first extensor compartment of the wrist, resulting in pain and swelling
Who is De Quervain’s tenosynvoitis most common in?
Women between ages of 30-50, especially those whose occupations or hobbies involve repetitive movement of the wrist
How many extensor compartments are there on the dorsal aspect of the wrist?
6
What do each of the extensor compartments on the dorsal aspect of the wrist contain?
Separate tendon groups
What tendon groups are found in the extensor compartments on the dorsal aspect of the wrist?
Extensor pollicis brevis and abductor pollicis longus
Extensor carpi radialis longus and brevis
Extensor pollicis longus
Extensor indicis and extensor digitorium
Extensor digiti minimi
Extensor carpi ulnaris
What tendons does De Quervain’s tenosynovitis involve?
Tendons of the extensor pollicis brevis and abductor pollicis longus
What are the main risk factors for developing De Quervain’s tenosynovitis?
Age between 30 and 50 years
Female gender
Pregnancy
Certain occupations or hobbies that involve repetitive movements of the hand and wrist
What will patients with De Quervain’s tenosynovitis complain of?
Pain near the base of the thumb with associated swelling
What causes swelling in De Quervain’s tenosynovitis?
Thickening of the tendon sheath
What movements are particularly painful and difficult in De Quervain’s tenosynovitis?
Movements involving grasping or pinching
What will be found on examination in De Quervain’s tenosynovitis?
Swelling and palpable thickening over the tendon group fibrous sheath
Finkelstein’s test is often positive
How is Finkelstein’s test done?
The patient makes a fist over their thumb, placing the thumb inside a closed fist and ulnar deviates their wrist
What is a positive Finkelstein’s test?
Pain felt in the radial styloid region
What is the limitation of Finkelstein’s test for De Quervain’s tenosynovitis?
The test can be painful even in the absence of De Quervain’s tenosynovitis, so you have to check bilaterally for any markedly increased pain on a specific side
What are the differential diagnoses of De Quervain’s tenosynovitis?
Arthritis of the carpometacarpal (CMC) joint
Intersection syndrome
Wartenberg’s syndrome
How can arthritis of the CMC joint be differentiated from De Quervain’s tenosynovitis?
It is more gradual in onset, usually with a negative Finkelstein’s test and positive grind test
What does the grind test involve?
Forcefully pushing the thumb against CMC joint whilst also rotating it slightly
What is a positive grind test result?
Pain felt on the volar side of the wrist
What is intersection syndrome?
Where the tendons of the first compartment cross over with those of the second compartment, resulting in pain felt over the second compartment
What is Wartenberg’s syndrome?
Neuritis of the superficial radial nerve
Who is Wartenberg’s syndrome often seen in?
Those wearing tight jewellery
How is a diagnosis of De Quervain’s tenosynovitis made?
Clinical diagnosis, with no investigations required
When might a plain hand radiograph be used in De Quervain’s tenosynovitis?
To exclude other diagnoses, e.g. CMC joint arthritis
What does conservative management of De Quervain’s tenosynovitis involve?
Lifestyle advice (avoid repetitive actions) Wrist splint
What is the role of steroid injections in De Quervain’s tenosynovitis?
They will reduce swelling and relieve pain in most cases, and they can be repeated several times if a good response is observed
What can be done for those failing to respond to conservative management?
Surgical decompression of the extensor compartment
What anaesthetic is used for surgical decompression of the extensor compartment?
Local or general
What does surgical decompression of the extensor compartment involve?
A transverse or longitudinal incision made, and the tendon sheath split in the central aspect in a longitudinal direction, thus allowing the tunnel roof to form again
How does surgical decompression of the extensor compartment help in De Quervain’s tenosynvoitis?
As the tunnel roof forms again, it heals wider and with more space for the tendons to move
What complications can arise from surgical compression in De Quervain’s tenosynovitis?
Failure to resolve
Reduced range of movements in wrist or hand
Neuroma formation
Nerve impingement
