MANUAL MINORS
De Quervain’s tenosynovitis is an inflammation of the tendons and their sheaths on the radial side of the wrist, specifically affecting the extensor pollicis brevis and abductor pollicis longus tendons. This condition often develops due to repetitive thumb and wrist movements, such as lifting objects, typing, or sports activities. Symptoms include pain at the base of the thumb, especially when moving it or rotating the wrist, as well as swelling and difficulty gripping objects.
Diagnosis
Diagnosis is clinical, based on the presence of pain on the radial side of the wrist. The Finkelstein’s test is the key diagnostic manoeuvre: pain is elicited by performing ulnar deviation of the wrist with the thumb inside the fist. Ultrasound may be useful to detect tendon thickening and inflammation of the tendon sheath.
Differential Diagnosis
Condition | Distinctive Characteristics |
|---|---|
Carpal tunnel syndrome | Paresthesia in the first three fingers, without localised pain on the radial side of the wrist. |
Wrist sprain | Generalised pain after trauma, not related to repetitive thumb movement. |
Base of thumb osteoarthritis | Chronic joint pain, more associated with prolonged use and joint stiffness. |
Extensor tendon rupture | Acute pain and loss of motor function in the thumb or wrist, with a history of trauma. |
Emergency Management
Initial management includes immobilising the wrist and thumb with a splint to limit movement and reduce inflammation. The use of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) is effective for pain control. Ice application to the affected area and limiting activities that exacerbate symptoms are recommended.
Definitive Treatment
Definitive treatment can be conservative, with prolonged immobilisation and physiotherapy to reduce inflammation and strengthen the tendons. In refractory cases, corticosteroid injections into the tendon sheath may be considered. If pain persists, surgical intervention may be necessary to release the affected tendons and allow them to move without friction.
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