De Quervain Tenosynovitis

35 y/o F with no h/o trauma presents with insidious onset wrist pain. Pain worse with gripping/grasping objects and picking up her 6 month old child. Pain is affecting her work as a calligrapher. Mild wrist swelling with tenderness upon palpation of radial styloid/anatomic snuff box, positive Finkelstein test, and negative grind test on exam.

  • Pain relief with diagnostic lidocaine injection of first extensor compartment

  • Treatment

    • Naproxen 500 mg BID

    • Mild case: Thumb spica splint for pain relief

    • Moderate to sever case: Administer glucocorticoid injection

Thumb spica splint

Thumb spica splint

Notes

  • Most common in females age 30-50 years

  • Inciting factors may include picking up a child or occupations that include prolonged gripping/grasping

  • Pathophysiology: Inflammation of the extensor pollicis brevis and abductor pollicis longus tendons that form the border of the anatomic snuff box

  • Diagnosis

    • Finkelstein test:

      • Arm is held with elbow at approximately 90 degrees with the radial aspect of the wrist superior. A fist is made with the fingers covering the thumb and the hand is flexed inferiorly at the wrist.

      • Good sensitivity and specificity

    • Grind test: Pressure is placed on the DIP of the thumb as it is rotated; a positive test would suggest basal thumb arthritis instead of de Quervain's tenosynovitis

    • Consider obtaining CBC, CRP, ESR if suspicious for infectious tenosynovitis

    • Pain relief with lidocaine rules out arthritic cause

  • Persistent inflammation may produce stenosing tenosynovitis