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