Trigger digits and de Quervain disease are the two most common forms of stenosing tenosynovitis.
Diagnosis is usually clinical.
If required, the single most useful and accurate investigation is a high-resolution ultrasound scan.
Treatment may involve nonsteroidal anti-inflammatory drugs, splinting, corticosteroid/local anesthetic injections, or surgery.
Tenosynovitis of the hand and wrist are 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
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
- 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
1st investigations to order
- high-resolution ultrasound scan
Investigations to consider
- plain radiograph of affected hand and wrist
- CT scan
de Quervain disease
extensor pollicis longus tenosynovitis
extensor carpi ulnaris tendon tenosynovitis
all other tenosynovitides
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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