De Quervain's Tenosynovitis

This is a common condition that affects the tendons that are used to straighten (extend) your thumb. The most common cause is overuse of the affected tendon. Rest of the affected tendon may be all that is required in some cases. Other treatments include pain relief, physiotherapy and steroid injections

Assessment

Signs and Symptoms

The typical symptom is pain over your wrist at the base of your thumb that is made worse by activity and eased by rest.

  • Radial wrist pain
  • Is a tenosynovitis affecting the abductor pollicis longus and extensor pollicis brevis tendons which form the anterior border of the anatomical snuffbox. The tendons normally share a single sheath
  • Often obvious precipitating factor e.g. mother repeatedly carrying new baby
  • Positive Finkelstein's test – place thumb within hand and bend the hand into ulnar deviation; pain is experienced in the region of the radial styloid process.
  • Usually responds very well to steroid injection

Management

Treatment options are

Conservative management by:

  • Advise the patient to avoid activities that cause pain, if possible.
  • Offering appropriate analgesia
  • Advise the patient to use a wrist/thumb splint. It needs to immobilise the thumb as well as the wrist.

Steroid injection, relieves the pain in about 70% of cases.

Review diagnosis/consider re-injection (ensure 4-6 weeks between injections)

Referral

Referral Criteria

Refer to hand clinic if conservative measures have failed.

Referral Instructions

Refer to the Hand Clinic (Orthopaedics/Plastics)

e-Referral Service

  • Specialty: Orthopaedics
  • Clinic Type: Hand and Wrist
  • Service: DRSS-Northern-Orthopaedics-Hand & Wrist- Devon CCG- 15N

Referral Forms

DRSS Referral forms

Supporting Information

Patient Information

British Society for Surgery of the Hand

Pathway Group

This guideline has been signed off on behalf of the Western Locality of NEW Devon CCG.

Publication date: 28 September 2015

 

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