De Quervain’s disease
Definition
- Aseptic inflammation or tendinosis of the sheath that surrounds the tendons of abductor pollicus longus and extensor pollicis brevis
- These muscles are responsible for radial abduction of the thumb away from the hand
Etiology
- Repetitive thumb movements
- Repetitive eccentric lowering of the wrist into ulnar deviation
- Carrying stack of dishes
Pathogenesis
- The tendons run in the synovial sheath which allows them to function seperately from the position of the wrist
- Inflammation causes thickening and myxoid degeneration of the sheath which impairs the function of the tendons and causes pain
Clinical manifestations
- Pain, tenderness & swelling over thumb side of wrist
- Difficulty in gripping
- A "sticking" or "stop-and-go" sensation in the thumb when moving it.
Diagnosis
- Finkelstein Test- patient makes fist with thumb inside the other fingers → stabilizes forearm with one hand → deviates fist to ulnar side
- Upon inspection and palpation if there is swelling and sharp pain in the areas of the tendons of abductor pollicis longus & extensor pollicis brevis
Finkelstein Test
- Finkelstein Test is used to test for De Quervain's tenosynovitis of the 1st extensor compartment of the wrist.
- It was described by Harry Finkelstein (an American surgeon) in 1930.
- With the thumb flexed and the other fingers flexed around it. The wrist is moved into ulnar deviation either actively or passively by the examiner.
- Pain and crepitation above the radial styloid suggest nonspecific tenosynovitis of the abductor pollicis longus APL and the extensor pollicis brevis EPB.
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Treatment
- Local corticosteroid injections
- NSAIDS
- Surgical tendon decompression