Tenosynovitis of the hand and wrist
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 between fifth and sixth decades
- female sex
- history 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
1st investigations to order
- high-resolution ultrasound scan
Investigations 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 receives a salary as deputy editor of Journal of Hand Surgery.
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.
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–SCBT-MR–SPR–SSR practice parameter for the performance of magnetic resonance imaging (MRI) of the wrist
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