De Quervains Tenosynovitis Flashcards
What is De Quervains tenosynovitis
inflammation of the tendons within the first extensor compartment of the wrist, resulting in wrist pain and swelling.
How many extensor compartments are there in the wrist
6
(1) Extensor pollicis brevis and abductor pollicis longus (2) Extensor carpi radialis longus and brevis (3) Extensor pollicis longus (4) Extensor indicis and extensor digitorum (5) Extensor digiti minimi (6) Extensor carpi ulnaris
what are the risk factors for De Quervains tenosynovitis
Age - most common in ages between 30-50
Female gender
Pregnancy
what are the clinical features
Pain near the base of the thumb
Associated swelling
What test could you do to look for de Quervains tenosynovitis
Finkelsteins test
- longitudinal traction and ulnar deviation to the affected thumb.
Pain specifically at the radial styloid process and along the length of the extensor pollicis brevis and abductor pollicis longus tendons is a positive test for De Quervain’s tenosynovitis.
What are the differential diagnosis
Arthritis of Carpometacarpal (CMC) joint - will have negative finkelsteins test and positive grind test
Intersection syndrome
Wartenberg’s syndrome
What are the investigations needed
It’s a clinical diagnosis therefore no investigations are needed
Hand x ray may be carried out to rule out other pathologies
What is the conservative management of DQT
Avoid repetitive actions
Wrist splint
Steroid injections
What is the surgical management of DQT
surgical decompression of the extensor compartment can be performed under local or general anaesthetic. This involves 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 as it heals but wider and with more space for the tendons to move.
What are the complications from surgical decompression
Failure to resolve
Reduce range of movement
Neuroma formation
Nerve impingement
