Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • location over and around a retinacular sheath
  • pain increased with motion
  • response to anesthetic injection
  • painful popping sensation with finger flexion and extension (trigger finger)
  • palpable nodule at the level of the metacarpal head (trigger finger)
  • pain, tenderness, and swelling localized to radial side of wrist (de Quervain disease)
  • pain and swelling proximal to wrist joint (intersection syndrome)
  • pain, swelling, tenderness at Lister tubercle (extensor pollicis longus tenosynovitis)
  • ulnar-sided wrist pain (extensor carpi ulnaris tenosynovitis)
  • pain at palmar wrist crease over scaphoid tubercle and along length of tendon (flexor carpi radialis tenosynovitis)

Other diagnostic factors

  • symptom duration over weeks to months

Risk factors

  • age between fifth and sixth decades
  • female gender
  • hx of current concomitant conditions with similar pathology (stenosing tendinopathy or neuropathy)
  • involvement of dominant hand
  • insulin-dependent diabetes
  • pregnancy and lactation
  • degenerative joint disease or trauma

Diagnostic investigations

1st investigations to order

  • high-resolution ultrasound scan
Full details

Investigations to consider

  • plain radiograph of affected hand and wrist
  • CBC
  • ESR
  • CRP
  • MRI
  • CT scan
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor

Department of Orthopaedic Surgery

University of Connecticut Health Center

New England Musculoskeletal Institute

Farmington

CT

Disclosures

JMW receives research funding from the US Department of Defense and American Society for Surgery of the Hand. She receives a salary as deputy editor of Journal of Hand Surgery and updates editor of the textbook Skeletal Trauma.

Dr Jennifer Moriatis Wolf would like to gratefully acknowledge Dr Doug Campbell, Dr Peter Evans, and Dr Shafic Sraj, the previous contributors to this monograph. DC, PE, and SS declare that they have no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Orthopedic Surgery

Harvard Medical School

Brigham and Women's Hospital

Boston

MA

Disclosures

PEB declares that he has no competing interests.

Director and Head

Department of Plastic, Hand and Reconstructive Microsurgery and Burns

Ganga Hospital

Coimbatore

India

Disclosures

SRS declares that he has no competing interests.

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