De Quervain tenosynovitis

Background

• Tenosynovitis of abductor pollicis, extensor pollicis brevis (where tendons lie in groove of radial styloid)

Clinical Features

• Pain along radial aspect of wrist (may radiate to thumb or extend into the forearm)
• Finkelstein test is positive
  • Pt grasps thumb in palm of the hand and ulnar deviates the thumb and hand
    • This stretches the tendons over the radial styloid producing sharp pain

Differential Diagnosis

Hand and finger injuries

• Distal finger
  • Finger amputation
  • Fingertip laceration
  • Nail avulsion
  • Nailbed laceration
  • Subungual hematoma
• Other finger/thumb
  • Boutonniere deformity
  • Mallet finger
    • Swan neck deformity
  • Jammed finger
  • Jersey finger
  • Trigger finger
  • Ring avulsion injury
  • De Quervain tenosynovitis
  • Infiltrative tenosynovitis
  • Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
• Hand
  • Dupuytren contracture
• Wrist
  • Drummer's wrist
  • Ganglion cyst
  • Lunotriquetral ligament instability
  • Scaphoid fracture
  • Extensor digitorum tenosynovitis
  • Compressive neuropathy ("bracelet syndrome")
  • Intersection syndrome
  • Snapping Extensor Carpi Ulnaris
  • Vaughn Jackson syndrome
• General
  • Hand and finger dislocations
  • Hand and finger fractures
  • Hand and finger infections
  • Gout and pseudogout
  • Hand and finger tendon injuries
  • High-pressure injection injury
  • Osteoarthritis
  • Rheumatoid arthritis
  • Ring removal

Treatment

• Splint thumb and wrist
  • Instruct pt to remove splint briefly each day to perform range-of-motion exercises
• NSAIDs x 10-14d
• Persistent cases may require steroid injection or surgical decompression

See Also

• Radiograph-Negative Hand and Finger Injuries

References

• Tintinalli
• Atlas of Emergency Medicine