Trigger digits and de Quervain's disease are the 2 most common forms of tenosynovitis tendinopathy.
Diagnosis is usually clinical.
If required, the single most useful and accurate investigation is a high-resolution ultrasound scan.
Treatment may involve non-steroidal anti-inflammatory drugs, splinting, corticosteroid/local anaesthetic injections, or surgery.
Tenosynovitis of the hand and wrist is a group of entities with a common pathology involving the extrinsic tendons of the hand and wrist and their corresponding retinacular sheaths. They usually start as tendon irritation manifesting as pain, and can progress to catching and locking when tendon gliding fails.
History and exam
- 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)
Jennifer Moriatis Wolf, MD
Department of Orthopaedic Surgery and Rehabilitation
University of Chicago Hospitals
JMW receives a salary as deputy editor of Journal of Hand Surgery.
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.
Philip E. Blazar, MD
Assistant Professor of Orthopedic Surgery
Harvard Medical School
Brigham and Women's Hospital
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
SRS declares that he has no competing interests.
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