De Quervain`s Tenosynovitis
Clinical appearance This condition is characterized by disabling pain in the radial aspect of the wrist at the base of the thumb. Its pathogenesis is similar to the trigger finger. There is swelling and tenderness of the common sheath of the abductor pollicis longus and extensor pollicis brevis, both tendons outlining the anterior edge of the anatomic snuffbox. Women are more frequently affected than men. De Quervain's tenosynovitis is particularly common in two settings: in mothers who repeatedly lift infants and young children and in people who use their hands in repetitive activities, such as knitting, sewing, and gardening. A positive Finkelstein's test is characteristic of the condition; in the painful hand, (a) the fully flexed thumb rests on the palm; (b) the fingers are curled over the thumb; and (c) the wrist is very gently deviated to the ulnar side. Acute pain along the tendon is diagnostic of de Quervain's tenosynovitis. Additional findings can include a diffusely swollen and tender sheath or loculated tenosynovial effusions near the radial styloid. Differential diagnosis Conditions that cause radial wrist pain could be confused with de Quervain's tenosynovitis. These conditions are listed in Table 3. Treatment Corticosteroid infiltrations (1 to 3) are very effective in de Quervain's tenosynovitis, although the success rate is slightly less than in trigger finger (8). Surgery is indicated in the event of treatment failures. Role of the primary care physician The primary care physician should be able to diagnose de Quervain's tenosynovitis and distinguish it from other causes of wrist pain. Infiltrations for this condition are technically demanding and may be best approached by a specialist. Key issues De Quervain's tenosynovitis causes severe pain and disables the hand. Diagnosis is confirmed by Finkelstein's maneuver. Treatment promptly eliminates pain and leads to a rapid restoration of hand function.
|
