Tenosynovitis of the hand and wrist
小结
定义
病史和体格检查
关键诊断因素
- 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)
其他诊断因素
- symptom duration over weeks to months
危险因素
- 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
诊断性检查
首要检查
- high-resolution ultrasound scan
需考虑的检查
- plain radiograph of affected hand and wrist
- CBC
- ESR
- CRP
- MRI
- CT scan
治疗流程
trigger finger
de Quervain disease
extensor pollicis longus tenosynovitis
extensor carpi ulnaris tendon tenosynovitis
all other tenosynovitides
撰稿人
作者
Jennifer Moriatis Wolf, MD
Professor
Department of Orthopaedic Surgery and Rehabilitation
University of Chicago Hospitals
Chicago
IL
利益声明
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.
鸣谢
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.
同行评议者
Philip E. Blazar, MD
Assistant Professor of Orthopedic Surgery
Harvard Medical School
Brigham and Women's Hospital
Boston
MA
利益声明
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
利益声明
SRS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
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].全文
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].全文
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].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Osteoarthritis (for de Quervain, flexor carpi radialis tenosynovitis)
- Occult fracture (e.g., scaphoid)
- Cellulitis
更多 鉴别诊断指南
- 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
更多 指南患者教育信息
Gout
Osteoarthritis
更多 患者教育信息
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