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De Quervain's Tenosynovitis Guide
- 1. D E Q U E R VA I N ’ S T E N O S Y N O V I T I S NURUL WAJIIHAH BINTI MOHAMAD AZALAN (1120531)
- 2. DEFINITION • Inflammation of the synovial sheath • Causing secondary thickening of the sheath, • Stenosis of the compartment • Thus compromising the involved tendon (APL & EPB). Apley’s System of Orthopaedics & Fractures 9th Edition
- 4. Six compartments of extensor retinaculum
- 5. CAUSES • Caused by unaccustomed overuse (relies on repetitive hand or wrist movement): – working in the garden – playing golf – lifting baby • Idiopathic Apley’s System of Orthopaedics & Fractures 9th Edition
- 6. PATHOLOGY • Reactive thickening of the sheath around the extensor pollicis brevis and abductor pollicis longus tendons within the first extensor compartment Apley’s System of Orthopaedics & Fractures 9th Edition
- 7. CLINICAL FEATURES • Pain on the radial side of the wrist – Tenderness is most acute at the very tip of the radial styloid • Visible swelling over the radial styloid • The tendon sheath feels thick and hard Apley’s System of Orthopaedics & Fractures 9th Edition
- 8. SPECIAL TEST • 1) Finkelstein’s test. – Ask the patient to fully flex the thumb. – Places the patient’s thumb across the palm in full flexion – Holding the patient’s hand firmly – Adduct the wrist joint (ulnar deviation) – In a positive test, this would be painful. Apley’s System of Orthopaedics & Fractures 9th
- 9. • 2) Hitch-hiker’s sign (resisted thumb extension) – Ask the patient to do: – Flexion of the MCP joint – Extension of distal IP joint of the thumb. – Patient complains of pain localized to 1st dorsal compartment when asked to extend & abduct the thumb Apley’s System of Orthopaedics & Fractures 9th
- 10. TREATMENT • Early case: corticosteroid injection into the tendon sheath. • Hand therapy ( splintage) • Resistant cases (if pain persists/severe cases) need an operation (slitting the thickened tendon sheath). Apley’s System of Orthopaedics & Fractures 9th
- 12. REFERENCE • Solomon L, Warwick D, Nayagam S. Apley and Solomon's System of Orthopaedics and Trauma, Ninth Edition. Hoboken: CRC Press; 2016. • http://clinicalgate.com/1-examination-of-the-hand-and-wrist/
Hinweis der Redaktion
- Particularly in middle aged n sometimes pregnancy
- Extensor retinaculum has 6 compartments which transmit tendons lined with synovium. 1st dorsal compartment (APB & EPB) & 2nd dorsal compartment (ECRB) are most commonly affected.
- Particularly in middle aged woman (40-50) n sometimes pregnancy
- differential 1. Rheumatoid arthritis at the base of the thumb 2. scaphoid non-union 3. Intersection syndrome
- Painful because it stretches the tendons of 1st dorsal compartment. Pathognomonic sign
- Sometimes there is duplication of tendons and even of the sheathboth sheaths need to be divided Care should be taken to prevent injury to the branches of radial nerve ,cause intractable dysaesthesia