De Quervain Tenosynovitis Clerk 陳冠榮
Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons in the first dorsal compartment Most commonly occurs in middle-aged women (6-10 times than men) Frequently repetitive thumb motion Rheumatoid arthritis
Pain and swelling in the region of the radial styloid that are aggravated by use of the thumb. Crepitus may be sensed as the compartment is palpated during thumb motion. Sometimes a thickening of the fibrous sheath is palpable
The Finkelstein test usually is positive: “on grasping the patient's thumb and quickly abducting the hand ulnarward, the pain over the styloid tip is excruciating. The patient's history and occupation, the radiographs, and other physical findings also must be considered Radiographs are typically normal and are used to exclude other possibilities, such as used to exclude fracture of the scaphoid or arthritis of the wrist or thumb CMC joint.
Conservative treatment Rest on a splint NSAID The injection of a steroid preparation into the tendon sheath Most successful within the first 6 weeks after onset Surgical treatment to release the area of stenosis is indicated for relief of persistent symptoms.
Anatomical variations are common in the first dorsal compartment. Reports of separate compartments found at surgery vary from 20% to 58%. More than half of patients may have “aberrant” or duplicated tendons, usually the abductor pollicis longus. The presence of these variations and failure to deal with them at the time of surgery may account for any persistence of pain.
Aftertreatment Failure to obtain complete relief after surgery may result from (1) formation of a neuroma in a severed branch of the superficial radial nerve, (2) volar subluxation of the tendon when too much of the sheath is removed, (3) failure to find and release a separate aberrant tendon within a separate compartment, and (4) hypertrophy of scar from a longitudinal skin incision.
References Netter’s Orthopaedics, 2006 Campbell’s Orthopaedics, 11th edition