Tenosynovitis of the hand and wrist
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- 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)
Otros factores de diagnóstico
- symptom duration over weeks to months
Factores de riesgo
- 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
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- high-resolution ultrasound scan
Pruebas diagnósticas que deben considerarse
- plain radiograph of affected hand and wrist
- CBC
- ESR
- CRP
- MRI
- CT scan
Algoritmo de tratamiento
trigger finger
de Quervain disease
extensor pollicis longus tenosynovitis
extensor carpi ulnaris tendon tenosynovitis
all other tenosynovitides
Colaboradores
Autores
Jennifer Moriatis Wolf, MD
Professor
Department of Orthopaedic Surgery and Rehabilitation
University of Chicago Hospitals
Chicago
IL
Divulgaciones
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.
Agradecimientos
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.
Revisores por pares
Philip E. Blazar, MD
Assistant Professor of Orthopedic Surgery
Harvard Medical School
Brigham and Women's Hospital
Boston
MA
Divulgaciones
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
Divulgaciones
SRS declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
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].Texto completo
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].Texto completo
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].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Osteoarthritis (for de Quervain, flexor carpi radialis tenosynovitis)
- Occult fracture (e.g., scaphoid)
- Cellulitis
Más DiferencialesGuías de práctica clínica
- 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
Más Guías de práctica clínicaFolletos para el paciente
Gout
Osteoarthritis
Más Folletos para el paciente
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