Last reviewed:September 2019
Last updated:March  2018

Summary

Definition

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)
Full details

Other diagnostic factors

  • symptom duration over weeks to months
Full details

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
Full details

Diagnostic investigations

1st investigations to order

  • high-resolution ultrasound scan
Full details

Investigations to consider

  • plain x-ray of affected hand and wrist
  • FBC
  • ESR
  • CRP
  • MRI
  • CT scan
Full details

Treatment algorithm

ACUTE

trigger finger

de Quervain's disease

extensor pollicis longus tenosynovitis

extensor carpi ulnaris tendon tenosynovitis

all other tenosynovitides

Contributors

AuthorsVIEW ALL

Professor

Department of Orthopaedic Surgery and Rehabilitation

University of Chicago Hospitals

Chicago

IL

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 reviewersVIEW 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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