Chapter 31 - Tendinopathy of the Hand and Wrist

Question 1

trigger finger pathology

Answer 1

stenosing tenosynovitis, 2:1 women, pathologic changes in the affected pulleys -> proliferation of chondrocytes and increased type III collagen

Question 2

which flexor tendon develops a nodule in trigger finger?

Answer 2

FDP - FDS remains unaffected

Question 3

how frequently are each of the tendons affected in trigger finger?

Answer 3

thumb > ring > long > small > index

Question 4

risk factors for trigger finger

Answer 4

DM!!
hypothyroid, sarcoid, RA, gout, calcific tendinitis, pseudogout

Question 5

green classification of trigger finger

Answer 5

I: pain over A1 pulley
II: mechanical catching without locking
III: passively correctable mechanical locking
IV: fixed deformity

Question 6

dequervain cause

Answer 6

stenosis of the first dorsal compartment - houses the APL and EPB

NOTE*** IN 40% of the population, the EPB has its own subsheath (and 80% of people requiring release will have a separate subsheath)

AND APL can have as many as 7 slips

Question 7

dequervain epidemiology

Answer 7

6x more common in women

peaks in 5/6th decades of life, pregnancy, and lactation

Question 8

rates of success with non-op tx of dequervain?

Answer 8

50-80% of patients resolve with one or two CSI

predictors of non-op failure - EPB subsheath, or mechanical clicking of the thumb

Question 9

how do you know you have released the epb?

Answer 9

• pull on tendon and you get thumb MCP extension
• epb has the more distal muscle belly

Question 10

intersection syndrome

Answer 10

inflammation at the intersection of the first nd second dorsal extensor compartments

pain 6cm proximal to radial styloid

if surgery is necessary: 2nd extensor compartment release and tendon debridement

Question 11

EPL tendinitis

Answer 11

rare - most commonly occurs in setting of non-displaced distal radius frature

prodrome to rupture

pain just ulnar to listers with active thumb IP extension

tx: epl compartment release and transposition DORSAL to the extensor retinaculum

Question 12

FCR tendinitis

Answer 12

concomitant STT arthrosis

women, 5th decade

non-op

Question 13

ECU tendinitis

Answer 13

common

ECU ulnarly deviates wrist when pronated, extends the wrist when supinated

Question 14

Test for ECU tendinitis

Answer 14

ECU synergy test: elbow on table fingers up, examiner grabs thumb and LF and radially deviates thumb