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 50 to 60 years
- female sex
- history of current concomitant conditions with similar pathology (stenosing tendinopathy or neuropathy)
- involvement of dominant hand
- insulin-dependent diabetes mellitus
- pregnancy and lactation
- degenerative joint disease or trauma
- hyperlipidemia
Diagnostic tests
1st tests to order
- high-resolution ultrasound scan
Tests to consider
- plain radiograph of affected hand and wrist
- CBC
- ESR
- CRP
- MRI
- CT scan
Treatment algorithm
trigger finger
de Quervain disease
extensor pollicis longus tenosynovitis
extensor carpi ulnaris tendon tenosynovitis
all other tenosynovitides
Contributors
Authors
Jennifer Moriatis Wolf, MD
Professor
Department of Orthopaedic Surgery and Rehabilitation
University of Chicago Hospitals
Chicago
IL
Disclosures
JMW will join the board of the Journal of Bone and Joint Surgery (American volume) starting October 2024. JMW declares that she is Board Member - Past President of American Society for Surgery of the Hand. Her stock ownership of Unify Medical has ended.
Acknowledgements
Dr Jennifer Moriatis Wolf would like to gratefully acknowledge Dr Doug Campbell, Dr Peter Evans, and Dr Shafic Sraj, the previous contributors to this topic. DC, PE, and SS declare that they have no competing interests.
Peer reviewers
Philip E. Blazar, MD
Assistant Professor of Orthopedic Surgery
Harvard Medical School
Brigham and Women's Hospital
Boston
MA
Disclosures
PEB declares that he has no competing interests.
S. Raja Sabapathy, MS, MCh, DNB, FRCS, MAMS
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.
References
Key articles
American College of Radiology. ACR-SABI-SPR-SSR practice parameter for the performance of magnetic resonance imaging (MRI) of the wrist. Aug 2023 [internet publication].Full text
American College of Radiology. ACR-SPR-SSR practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the fingers and toes. 2023 [internet publication].Full text
American College of Radiology. ACR–SPR–SSR practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of bone, joint, and soft tissue infections in the extremities. 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Osteoarthritis (for de Quervain, flexor carpi radialis tenosynovitis)
- Occult fracture (e.g., scaphoid)
- Cellulitis
More DifferentialsGuidelines
- ACR-SPR-SSR practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the fingers and toes
- ACR-SABI-SPR-SSR practice parameter for the performance of magnetic resonance imaging (MRI) of the wrist
More GuidelinesPatient information
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