Tenosynovitis of the hand and wrist

Last reviewed: 7 Jan 2023
Last updated: 07 Aug 2020



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)
More key diagnostic factors

Other diagnostic factors

  • symptom duration over weeks to months
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • high-resolution ultrasound scan
More 1st investigations to order

Investigations to consider

  • plain radiograph of affected hand and wrist
  • CBC
  • ESR
  • CRP
  • MRI
  • CT scan
More investigations to consider

Treatment algorithm


trigger finger

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.

Peer reviewers

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

Ganga Hospital




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–SCBT-MR–SPR–SSR practice parameter for the performance of magnetic resonance imaging (MRI) of the wrist
    More Guidelines
  • Patient leaflets



    More Patient leaflets
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