Last reviewed: June 2020
Last updated: March  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • location over and around a retinacular sheath
  • pain increased with motion
  • response to anaesthetic 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 localised to radial side of wrist (de Quervain's disease)
  • pain and swelling proximal to wrist joint (intersection syndrome)
  • pain, swelling, tenderness at Lister's 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 sex
  • 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

Investigations to consider

  • plain x-ray of affected hand and wrist
  • FBC
  • ESR
  • CRP
  • MRI
  • CT scan
More investigations to consider

Treatment algorithm



Department of Orthopaedic Surgery and Rehabilitation

University of Chicago Hospitals




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 reviewersVIEW ALL

Assistant Professor of Orthopedic Surgery

Harvard Medical School

Brigham and Women's Hospital




PEB declares that he has no competing interests.

Director and Head

Department of Plastic, Hand and Reconstructive Microsurgery and Burns

Ganga Hospital




SRS declares that he has no competing interests.

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