Hand tendon injuries (incl. DeQuervain, trigger finger) Flashcards
What are the most common forms of tenosynovitis tendinopathy of the hand and wrist?
- Trigger digits
- de Quervain’s disease
What is the range of severity of tenosynovitis in the hand/wrist?
They usually start as tendon irritation manifesting as pain, and can progress to catching and locking when tendon gliding fails
What test is used for De Quervain’s tenosynovitis?
Finklestein’s test is a test for tenosynovitis of the 1st extensor compartment at the wrist (De Quervain’s tenosynovitis)
List 5 risk factors for de Quervain’s tenosynovitis of the hand/wrist.
- Age between fifth and sixth decades
- Female sex
- Hx of current concomitant conditions with similar pathology (stenosing tendinopathy or neuropathy)
- Involvement of dominant hand
- Insulin-dependent diabetes
- Pregnancy and lactation
What is the pathophysiology of De Quervain’s tenosynovitis?
Tendons running into thumb run through a sheath which becomes inflammed and causes pain
What causes tenosynovitis?
- More common in women after pregnancy
- Unknown in most cases
- Overuse or repetitive movement
- Sometimes caused by simple strain, work or sports
What is the management of De Quervain’s tenosynovitis?
Usually self-resolves within a few weeks in mild cases.
- Rest + avoid activties which cause strain
- Wrist brace
- Simple analgesia
- Ice - e.g. every 2hrs for 20mins for 1-2 days
Other:
- Physiotherapy
- Specialist referral
- Steroid injection
- Surgery
If clinical diagnosis is uncertain, what is the most useful test or hand/wrist tenosynovitis diagnosis?
Most useful and accurate investigation is a high-resolution ultrasound scan.
What are the clinical features of de Quervain’s tenosynovitis?
- Risk factor presence
- Pain
- Tenderness +/- swelling localised to radial side of wrist - 1 to 2 cm proximal to the radial styloid aggrevated by thumb movement
- Finkelstein’s test positive - exacerbates pain with ulnar deviation with clasped thumb in palm
- Improvement with anaesthetic+corticosteroid injection
- Symptom duration weeks to months
What are the clinical features of trigger finger?
- Presence of risk factors
- Painful popping/clicking sensation with finger flexion and extension
- Palpable nodule at the level of the metacarpal head in the palm
- May be worse in the morning
- Response to anaesthetic/corticosteroid injection
- Symptom duration weeks to months
Which finger is most commonly affected in trigger finger?
Ring finger = prevents it from straightening fully
Also middle finger or thumb are commonly affected.
What is trigger finger?
A trigger finger (also known as stenosing flexor tenosynovitis) is a finger that becomes ‘locked’ after it has been bent (flexed) or locked in a bent position. It is difficult to straighten out without pulling on it by the other hand.
It is thought to be caused by a disparity between the size of the tendon and pulleys through which they pass. In simple terms the tendon becomes ‘stuck’ and cannot pass smoothly through the pulley.
What are the risk factors for trigger finger?
Sometimes occurs for no reason
More common:
- After jobs which involve a lot of screwdriver use.
- After working with tools that press on the palm.
- 40yo or older
- Female
- Previous injury to palm or fingers
- Presence of other conditions e.g. RhA, amyloidosis, diabetes, hypothyroid, Dupuytren’s, carpal tunnel
What is the management of trigger finger?
1 in 5 self-resolve with conservative measures
- Simple analegsia
- Splinting - keeping the affected finger completely straight
- Anaesthetic/steroid injection
- Surgery - to widen the tendon sheath, under local anaesthetic
If there is direct tenderness over corresponding joint but no tenderness over the suspected tendon, what is a differentia?
Osteoarthritis - ix include XR or the hands/wrist
What are the complications of trigger finger?
- Prolonged neglect of a locked digit will result in joint flexion contracture
- Surgery related complications - tendon bow-stringing (shown) or subluxation
- Neuritis - prolonged irritation and surrounding inflammation may involve nearby sensory nerves.
