De Quervain's Tenosynovitis Flashcards
What is DQT?
Inflammation of the tendons within the first extensor compartment of the wrist
Epidemiology of DQT
Most common in women
Age 30-50
Occupations or hobbies involving repetitive movements of the wrist
Extensor compartments in the wrist lateral to medial
1 - EPB and APL
2 - ECRL + ECRB
3 - EPL
4 - Extensor indicis and Extensor digitorum
5 - Extensor digiti minimi
6 - Extensor carpi ulnaris
Risk factors
Age (30-50)
Female
Pregnancy
Occupations and hobbies involving repetitive movements
Clinical features
Pain near the base of the thumb
Associated swelling due to thickening of the tendon sheath
Grasping and pinching can be painful and difficult
Examination findings
Swelling and palpable thickening over there tendon group fibrous sheath
What special test is done?
Finkelstein’s test
Explain Finkelstein’s test
Apply longitudinal traction and ulnar deviation to the affected thumb
+ve = Pain at the radial styloid and along the length of EPB and APL
Dx
Arthritis of CMC joint (more gradual in onset and usually Finkelstein’s test -ve but Grind test +ve)
Intersection syndrome (Tendons of 1st comp cross of 2nd comp -> pain felt over second compartment)
Wartenberg’s syndrome (neuritis of superficial radial nerve, often seen in those wearing tight jewellery)
Ix
DQT is a clinical diagnosis no investigations are required
X-ray might be done to exclude dx like CMC joint OA
Management
Initially conservative
Surgical if failing to respond to conservative
Conservative management
Lifestyle advice to avoid repetitive actions + wrist splint
Steroid injections to reduce swelling and relieve pain and can be done repeatedly.
Surgical intervention
Decompression of the extensor compartment under local or general anaesthetic
Involves a transverse or longitudinal incision and then the tendon sheath is split in the central aspect in a longitudinal direction.
This allows the tunnel roof to form again as it heals, but wider and with more space for the tendons to move.
Complications from surgical decompression.
Failure to resolve
Reduced range of motion
Neuroma formation
Nerve impingement
