Hand and Wrist Tendonitis and Tenosynovities

DeQuervain's Symptoms - Visible swelling most often

0.5 in proximal to radial styloid

DeQuervain's Disease described initially in

1895

Most commonly Tenosynovitis is in

1st 2nd 6th compartments

DeQuervain's Acute Treatment - Thumb spica

3 weeks Wrist in 15 deg extension midway between palmer ABD and ADD, thumb MP joint in 10 deg flexion

Intersection Syndrome - Pain and swelling are noted where

4-6 cm proximal to radial carpal joint on dorsal surface of the forearm

Intersection Syndrome - At least ___ weeks of conservative treatment before considering surgical interventions

6

DeQuervain's Disease Location

APL and EPB held in groove of the radius by firm segment of extensor retinaculum Microtrauma and inflammation begin in the tenosynovium or sheath (varies)

Kienbock's disease

AVN of lunate

Stenosing Tenosynovitis MOI

Activities that require repetitive thumb, finger, or wrist movement

Intersection Syndrome

An exertional compartment syndrome of the APL and EPB or degenerative changes in these muscles

Tenosynovitis may develop in

Any of six compartments

DeQuervain's Differential Diagnosis

Arthrosis of the CMC joint Scaphoid fracture Arthrosis of carpal joints Kienbocks's disease

Guyon's Tunnel Syndrome - Etiology

Blunt trauma Tumorous condition (lipoma, ganglion cyst) Fracture of hamate, 4th or 5th MC

DeQuervain's - Loss of

CMC abduction of thumb

Guyon's Tunnel Syndrome - What nerve

Compression of ulnar nerve in Guyon's Canal

Guyon's Tunnel Syndrome

Compression or irritation of the ulnar nerve lateral to the hook of the hamate

DeQuervain's Acute Treatment - May require

Cortisone Injection in 1st dorsal compartment

DeQuervain's Symptoms

May report gradual onset of symptoms Dull ache over radial aspect of hand/wrist May also note creaking or wet leather sign Visible swelling Positive Finklestein's test May be painful cyst over first dorsal compartment Papable thickening of extensor sheath and of tendons distal to extensor tunnel

2nd Compartment

Extensor Carpi Radialis Longus (ECRL) Extensor Carpi Radialis Brevis (ECRB)

6th Compartment

Extensor Carpi Ulnaris

1st Compartment

Extensor Pollicis Brevis (EPB) Abductor Pollicis Longus (APL)

DeQuervain's Syndrome Activities requiring

Forceful grasp couple with ulnar deviation Hammering bowling golf typing sewing knitting fishing or direct trauma tennis squash and badminton are examples

DeQuervain's - Wrist pain may radiate into

Forearm or thumb

Intersection Syndrome - What motion will be weak and painful

Grip

Guyon's Tunnel Syndrome is also known as

Handle Bar Palsy

DeQuervain's Subacute Treatment

Heat Phonophoresis Iontophoresis Activity modification Tendon gliding/stretching PRE as described previously when done pain-free

Tenosynovitis typically occurs

In the wrist and hand where tendons pass through synovial lined sheaths and retinacula

Intersection Syndrome - What else occurs at the intersection of APL and EPB and ECRL and ECRB

Inflammation of adventitial bursa formation

Tenosynovitis

Inflammation of the synovium surrounding the tendon

Intersection Syndrome - Location

Inflammatory condition located at the crossing point of 1st dorsal compartment muscles (APL and EPB) and radial wrist extensors (ECRL and ECRB)

DeQuervain's - Where is the tenderness

Just proximal to tip of radial styloid process

MOI that affect Wrist Extensors

Laborers and athletes Inflammation of distal wrist tendons Rowing, throwing, carrying bags, hammering

DeQuervain's Acute Treatment - Modalities

NSAIDs Transverse Friction Ultrasound Phono Moist Heat Cryotherapy

Tendonitis

Noninfectious inflammation of tendons including the attachments to muscles and bones

Tendonitis/Tenosynovitis As Treatment Improves Progress to

PRE 1-2 lb weight initially May use low load high repetition Eccentric exercises

Intersection Syndrome - Severe cases present with

Palpable and/or audible crepitus noted with wrist or thumb motion

DeQuervain's - Entrapment and compression of tendons especially with what motion

Radial deviation

DeQuervain's Acute Treatment

Rest Thumb spica splint immobilizing thumb in radial abduction

Tendonitis/Tenosynovitis Treatment

Rest Wrist splinted in 30 deg extension NSAID's Moist heat Gentle PROM and stretching AROM pain-free range

Intersection Syndrome is common in

Rowers Weightlifters Canoeists

Guyon's Tunnel Syndrome - Symptoms

Same symptoms and stages can be present with this disorder except involving the ulnar nerve and its distribution

Guyon's Tunnel Syndrome - Treatment

Similar to CTS Surgical intervention rarely required

Intersection Syndrome - Non Operative Rehabilitation Consists of

Splinting Anti inflammatory agents Corticosteroid injection Immobilization in thumb spica or cast Phonophoresis Deep friction massage

DeQuervain's Disease

Stenosing tenosynovitis of the 1st dorsal compartment of wrist (EPB and APL)

Intersection Syndrome is also described as

Stenosing tenosynovitis of the ECRL and ECRB

DeQuervain's Syndrome results in

Thickening of extensor retinaculum Narrowing of fibro-osseous canal

DeQuervain's - Pain with resisted

Thumb extension

Guyon's Tunnel - What runs through

Ulnar nerve and artery run through this tunnel and can be affected by space maintaining lesion or swelling

Tendonitis/Tenosynovitis Symptoms

Visable swelling Erythema Dull pain at rest that increases sharply during gripping or lifting Tendon tender to palpate

Guyon's Canal is bony canal formed by

Volar carpal ligament Hook of the hamate Hamate

DeQuervain's Disease is also known as

Washer Woman's Syndrome

Stenosing Tenosynovitis

When a chronically inflamed tendon sheath becomes thick and fibrosed, restricting tendon excursion