De quervain tenosynovitis Flashcards
What is De quervain tenosynovitis?
inflammation of the tendons within the first extensor compartment of the wrist resulting in wrist pain and swelling
What are the 6 extensor compartments of the wrist?
1) Extensor pollicis brevis and abductor policies longus
2) Extensor carpi radialis longus and brevis
3) extensor pollicis longus
4) extensor indices and extensor digitorum
5) extensor digiti minimi
6) extensor carpi ulnaris
Which extensor compartment does De quervain tenosynovitis involve?
Extensor pollicis brevis and abductor pollicis longus
What are the risk factors forDe quervain tenosynovitis?
age, female, pregnancy, repetitive movements
What are the clinical features of De quervain tenosynovitis?
pain near the base of the thumb with an associated swelling, secondary to thickening of the tendon sheath, grasping or pinching movement are painful, swelling and palpable thickening over the tendon sheath
What is Fickelsteins test?
Examiner applies longitudinal traction and ulnar deviation to the affected thumb, pain at the radial styloid process and along the length go the extensor pollicis brevis and abductor policies longus tendon is a positive test for De quervain tenosynovitis
What are the differential diagnosis for De quervain tenosynovitis?
Arthritis of carpometacarpal CMC joint
Intersection syndrome
Wartenberg syndrome
What investigations would be done for De quervain tenosynovitis?
clinical, but can do plain hand radiograph to exclude other diagnosis
What is the management of De quervain tenosynovitis?
lifestyle advice and a wrist splint, steroid injection, surgical decompression
What are some complications of surgical decompression surgery for De quervain tenosynovitis?
Failure to resolve, reduce range of movement in the wrist or hand, neuroma formation, nerve impingement
How would you tell the difference between arthritis of the carpomatacarpal and the De quervain tenosynovitis?
CMC joint arthritis will have a negative finkelstein test but a positive grind test- forcefully push the thumb against CMC joint whilst it is rotating slightly, pain will be on the volar side of the wrist
What is intersection syndrome?
Tendons of the first compartment cross over with the second compartment causing pain in the second compartment
What is Wartenberg syndrome?
Neuritis of the superficial radial nerve, usually seen in people wearing tight jewellery
