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Tenosynovitis of the hand and wrist

Last reviewed: 11 Nov 2024
Last updated: 23 Jul 2024

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)
Full details

Other diagnostic factors

  • symptom duration over weeks to months
Full details

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
Full details

Diagnostic tests

1st tests to order

  • high-resolution ultrasound scan
Full details

Tests to consider

  • plain radiograph of affected hand and wrist
  • CBC
  • ESR
  • CRP
  • MRI
  • CT scan
Full details

Treatment algorithm

ACUTE

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.

  • Tenosynovitis of the hand and wrist images
  • Differentials

    • Osteoarthritis (for de Quervain, flexor carpi radialis tenosynovitis)
    • Occult fracture (e.g., scaphoid)
    • Cellulitis
    More Differentials
  • Guidelines

    • 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 Guidelines
  • Patient information

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