De Quervain tenosynovitis - Revision history

ClaireLewis at 16:19, 18 October 2019

2019-10-18T16:19:28Z

Rossdonaldson1: /* Background */

2019-05-10T02:35:40Z

Background

← Older revision		Revision as of 02:35, 10 May 2019
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	==Background==		==Background==
	[[File:Gray424.png\|thumb\|The mucous sheaths of the tendons on the back of the wrist.]]		[[File:Gray424.png\|thumb\|The mucous sheaths of the tendons on the back of the wrist.]]
			[[File:Extensor compartments of wrist.JPG\|thumbnail\|extensor compartments of wrist]]
	*Tenosynovitis of abductor pollicis longus (APL), extensor pollicis brevis (EPB)		*Tenosynovitis of abductor pollicis longus (APL), extensor pollicis brevis (EPB)
	**Groove of radial styloid		**Groove of radial styloid
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	**Or secretarial, nursing occupations		**Or secretarial, nursing occupations
	**Recently, over-texting on phones has increasingly been the culprit		**Recently, over-texting on phones has increasingly been the culprit
	~~[[File:Extensor compartments of wrist.JPG\|thumbnail\|extensor compartments of wrist]]~~

	==Clinical Features<ref>Keon-Cohen B. De Quervain disease. J Bone Joint Surg Br. 1951;33-B(1):96-99 http://www.jbjs.org.uk/cgi/reprint/33-B/1/96.</ref>==		==Clinical Features<ref>Keon-Cohen B. De Quervain disease. J Bone Joint Surg Br. 1951;33-B(1):96-99 http://www.jbjs.org.uk/cgi/reprint/33-B/1/96.</ref>==

Rossdonaldson1: /* Background */

2019-05-10T02:35:25Z

Background

← Older revision		Revision as of 02:35, 10 May 2019
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	==Background==		==Background==
			[[File:Gray424.png\|thumb\|The mucous sheaths of the tendons on the back of the wrist.]]
	*Tenosynovitis of abductor pollicis longus (APL), extensor pollicis brevis (EPB)		*Tenosynovitis of abductor pollicis longus (APL), extensor pollicis brevis (EPB)
	**Groove of radial styloid		**Groove of radial styloid

Rossdonaldson1: /* Clinical FeaturesKeon-Cohen B. De Quervain disease. J Bone Joint Surg Br. 1951;33-B(1):96-99 http://www.jbjs.org.uk/cgi/reprint/33-B/1/96. */

2019-05-10T02:33:20Z

Clinical FeaturesKeon-Cohen B. De Quervain disease. J Bone Joint Surg Br. 1951;33-B(1):96-99 http://www.jbjs.org.uk/cgi/reprint/33-B/1/96.

← Older revision		Revision as of 02:33, 10 May 2019
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	==Clinical Features<ref>Keon-Cohen B. De Quervain disease. J Bone Joint Surg Br. 1951;33-B(1):96-99 http://www.jbjs.org.uk/cgi/reprint/33-B/1/96.</ref>==		==Clinical Features<ref>Keon-Cohen B. De Quervain disease. J Bone Joint Surg Br. 1951;33-B(1):96-99 http://www.jbjs.org.uk/cgi/reprint/33-B/1/96.</ref>==
			[[File:Finkelstein Test Arrow.jpg\|thumb\|The modified Eichoff maneuver, commonly called the "Finkelstein's test." The arrow mark indicates where the pain is worsened in de Quervain syndrome.]]
	*Pain along radial aspect of wrist (may radiate to thumb or extend into the forearm)		*Pain along radial aspect of wrist (may radiate to thumb or extend into the forearm)
	*Painful abduction of thumb		*Painful abduction of thumb

Rossdonaldson1 at 01:11, 10 May 2019

2019-05-10T01:11:43Z

← Older revision		Revision as of 01:11, 10 May 2019
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	[[Category:Orthopedics]]		[[Category:Orthopedics]]
			[[Category:Sports Medicine]]

Kxl328: /* Clinical FeaturesKeon-Cohen B. De Quervain disease. J Bone Joint Surg Br. 1951;33-B(1):96-99 http://www.jbjs.org.uk/cgi/reprint/33-B/1/96. */

2018-10-03T02:19:32Z

Clinical FeaturesKeon-Cohen B. De Quervain disease. J Bone Joint Surg Br. 1951;33-B(1):96-99 http://www.jbjs.org.uk/cgi/reprint/33-B/1/96.

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	*Decreased grip strength		*Decreased grip strength
	*Swelling at tendon sheath along radial styloid		*Swelling at tendon sheath along radial styloid
	*Positive ~~Finkelstein, pathognomonic~~		*Positive Eichoff test
	**Patient grasps thumb in palm of the hand and ulnar deviates the thumb and hand		**Patient grasps thumb in palm of the hand and ulnar deviates the thumb and hand
	**Stretches the tendons over the radial styloid producing sharp pain		**Stretches the tendons over the radial styloid producing sharp pain
			*Positive Finkelstein's test<ref>Ilyas A, Ast M, Schaffer AA, Thoder J (2007). De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. 15 (12): 757–64.</ref>
			**Practitioner grabs thumb and sharply ulnarly deviates, causing sharp pain
			**Done appropriately, produces less false positives than Eichoff test
	*Negative Phalen and Tinel test		*Negative Phalen and Tinel test

Rossdonaldson1: /* References */

2018-03-29T20:08:55Z

References

← Older revision		Revision as of 20:08, 29 March 2018
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	==References==		==References==
	*Diop AN, Ba-Diop S, Sane JC et-al. [Role of US in the management of de Quervain's tenosynovitis: review of 22 cases] J Radiol. 2008;89 (9 Patient 1): 1081-4.		<references/>
	*Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31 (2): 265-8.

	~~<references/>~~
	[[Category:Orthopedics]]		[[Category:Orthopedics]]

Rossdonaldson1 at 20:08, 29 March 2018

2018-03-29T20:08:01Z

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	{{Hand and finger injury DDX}}		{{Hand and finger injury DDX}}

	==Workup==		==Evaluation==
			===Workup===
	*ESR usually normal<ref>Ferri FF. Ferri's CLinical Advisor 2013. Elsevier Health Sciences, Jun 1, 2012.</ref>		*ESR usually normal<ref>Ferri FF. Ferri's CLinical Advisor 2013. Elsevier Health Sciences, Jun 1, 2012.</ref>
	*Consider [[arthrocentesis]] for joint effusion to evaluate for crystals, gram stain, culture		*Consider [[arthrocentesis]] for joint effusion to evaluate for crystals, gram stain, culture

	==Imaging<ref>Kamel M, Moghazy K, Eid H, Mansour R. Ultrasonographic diagnosis of de Quervain tenosynovitis. Ann Rheum Dis. 2002;61(11):1034-1035. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753934/pdf/v061p01034.pdf.</ref>==		===Imaging<ref>Kamel M, Moghazy K, Eid H, Mansour R. Ultrasonographic diagnosis of de Quervain tenosynovitis. Ann Rheum Dis. 2002;61(11):1034-1035. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753934/pdf/v061p01034.pdf.</ref>===
	*Plain films usually nondiagnostic		*Plain films usually nondiagnostic
	**May see soft tissue swelling or radial styloid sclerosis or erosion		**May see soft tissue swelling or radial styloid sclerosis or erosion

Josgood: /* ImagingKamel M, Moghazy K, Eid H, Mansour R. Ultrasonographic diagnosis of de Quervain tenosynovitis. Ann Rheum Dis. 2002;61(11):1034-1035. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753934/pdf/v061p01034.pdf. */

2017-09-25T12:18:39Z

ImagingKamel M, Moghazy K, Eid H, Mansour R. Ultrasonographic diagnosis of de Quervain tenosynovitis. Ann Rheum Dis. 2002;61(11):1034-1035. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753934/pdf/v061p01034.pdf.

← Older revision		Revision as of 12:18, 25 September 2017
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	**Important to rule out fracture, gas formation, late [[osteomyelitis]]		**Important to rule out fracture, gas formation, late [[osteomyelitis]]
	*US diagnostic		*US diagnostic
	**Thickened extensor retinaculum overlying radial styloid		**Thickened extensor retinaculum (>0.45mm)<ref>Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain's disease. J Orthop Sci. 2014, PMID: 24132793 </ref> overlying radial styloid
	**Thickened APL and EPB under extensor retinaculum, as contrasted with unaffected wrist		**Thickened APL and EPB under extensor retinaculum, as contrasted with unaffected wrist
	**Edema surrounding tendons within first dorsal wrist compartment		**Edema surrounding tendons within first dorsal wrist compartment

Josgood: /* Workup */

2017-09-25T12:12:08Z

Workup

← Older revision		Revision as of 12:12, 25 September 2017
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	==Workup==		==Workup==
	*ESR usually normal<ref>Ferri FF. Ferri's CLinical Advisor 2013. Elsevier Health Sciences, Jun 1, 2012.</ref>		*ESR usually normal<ref>Ferri FF. Ferri's CLinical Advisor 2013. Elsevier Health Sciences, Jun 1, 2012.</ref>
	*Consider arthrocentesis for joint effusion to evaluate for crystals, gram stain, culture		*Consider [[arthrocentesis]] for joint effusion to evaluate for crystals, gram stain, culture

	==Imaging<ref>Kamel M, Moghazy K, Eid H, Mansour R. Ultrasonographic diagnosis of de Quervain tenosynovitis. Ann Rheum Dis. 2002;61(11):1034-1035. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753934/pdf/v061p01034.pdf.</ref>==		==Imaging<ref>Kamel M, Moghazy K, Eid H, Mansour R. Ultrasonographic diagnosis of de Quervain tenosynovitis. Ann Rheum Dis. 2002;61(11):1034-1035. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753934/pdf/v061p01034.pdf.</ref>==

← Older revision		Revision as of 16:19, 18 October 2019
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	**May see soft tissue swelling or radial styloid sclerosis or erosion		**May see soft tissue swelling or radial styloid sclerosis or erosion
	**Important to rule out fracture, gas formation, late [[osteomyelitis]]		**Important to rule out fracture, gas formation, late [[osteomyelitis]]
	*US diagnostic		*[[ultrasound: Tendons\|US]] diagnostic
	**Thickened extensor retinaculum (>0.45mm)<ref>Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain's disease. J Orthop Sci. 2014, PMID: 24132793 </ref> overlying radial styloid		**Thickened extensor retinaculum (>0.45mm)<ref>Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain's disease. J Orthop Sci. 2014, PMID: 24132793 </ref> overlying radial styloid
	**Thickened APL and EPB under extensor retinaculum, as contrasted with unaffected wrist		**Thickened APL and EPB under extensor retinaculum, as contrasted with unaffected wrist
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	*[[NSAIDs]] for 10-14 days		*[[NSAIDs]] for 10-14 days
	*Persistent cases may require steroid injection or surgical decompression		*Persistent cases may require steroid injection or surgical decompression
	*First steroid injection provides permanent relief in ~50%		*First [[steroid]] injection provides permanent relief in ~50%
	**Second steroid injection > 1 mo later curative in another 40%<ref>Pagonis T, Ditsios K, Toli P, Givissis P, Christodoulou A. Improved corticosteroid treatment of recalcitrant de Quervain tenosynovitis with a novel 4-point injection technique. Am J Sports Med. 2011 Feb. 39(2):398-403.</ref>		**Second steroid injection > 1 mo later curative in another 40%<ref>Pagonis T, Ditsios K, Toli P, Givissis P, Christodoulou A. Improved corticosteroid treatment of recalcitrant de Quervain tenosynovitis with a novel 4-point injection technique. Am J Sports Med. 2011 Feb. 39(2):398-403.</ref>
	**0.5-1 cc of 1% lidocaine		**0.5-1 cc of 1% [[lidocaine]]
	**Plus 0.5-1 cc of long acting steroid (methylprednisolone acetate, triamcinolone)<ref>Stephens MB. Musculoskeletal Injections: A Review of the Evidence. Am Fam Physician. 2008 Oct 15;78(8):971-976.</ref>		**Plus 0.5-1 cc of long acting steroid ([[methylprednisolone]] acetate, [[triamcinolone]])<ref>Stephens MB. Musculoskeletal Injections: A Review of the Evidence. Am Fam Physician. 2008 Oct 15;78(8):971-976.</ref>
	*Intertendinous septum presence increases likelihood of needing surgery<ref>Stoller DW, Tirman PF, Bredella MA. Diagnostic imaging, Orthopaedics. Amirsys Inc. (2004) ISBN:0721629202.</ref>		*Intertendinous septum presence increases likelihood of needing surgery<ref>Stoller DW, Tirman PF, Bredella MA. Diagnostic imaging, Orthopaedics. Amirsys Inc. (2004) ISBN:0721629202.</ref>