De Quervain's tenosynovitis
Cards (8)
- De Quervian's tenosynovitis:
- Type of RSI resulting in pain on lateral aspect of the wrist
- Primarily affects 2 tendons - abductor pollicis longus and extensor pollicis brevis
- Tendon sheaths surround tendons and help to lubricate and protect movements of tendons - formed of synovial membrane that covers tendons and filled with synovial fluid
- The tendon sheaths pass under the extensor retinaculum - fibrous band that wraps across back of wrist
- Repetitive movements of these tendons under the extensor retinaculum results in inflammation and swelling of tendon sheaths
- Extensor pollicis brevis:
- Abducts thumb and wrist
- Tendon inserts into base of first metacarpal bone at base of thumb
- Extensor pollicis brevis:
- Abducts thumb and wrist
- Inserts into base of proximal phalynx of thumb
- Risk factors:
- Age: most common between 30-50 years
- More common in women
- Pregnancy
- Occupations or hobbies that involve repetitive movement of hand and wrist
- Presentation:
- Tenderness, aching or burning at lateral aspect of the wrist - typically over the radial styloid
- Can radiate into forearm
- Can be aggravated by holding or gripping objects
- Weakness
- Numbness
- Bilateral symptoms often seen in new parents due to repetitively lifting up baby - referred to as "mummy thumb"
- Finklestine/Eichoff test:
- Patient makes fist with thumb inside fingers
- Wrist adducted, deviated to ulnar side - causing strain on abductor pollicis longus and extensor pollicus brevis tendons
- If movement causes pain at radial aspect of wrist the test is positive indicating De Quervain's tenosynovitis
- Management:
- Usually a self-limiting condition that doesn't require intervention
- Rest and adapting activities
- Ice/heat
- Analgesia e.g. paracetamol, NSAIDs
- Splits to restrict movements
- Physiotherapy
- If conservative measures don't resolve pain refer to specialist for:
- Steroid injections
- Surgery to cut extensor retinaculum releasing pressure and creating more space for tendons