April 6, 2011 by dailybolusoflr
de Quervain’s disease (or de Quervain’s tenosynovitis)
· This condition presents with pain, swelling and tenderness at the radial side (thumb side) of the wrist
· It is aggravated by movement, especially when the wrist is deviated in the ulnar direction (towards the pinky). Patients also complain of pain with movement of their thumb, again, especially when it is moved in the ulnar direction.
· The most common cause is overuse, but it can result from trauma.
o New mothers are a large portion of patients afflicted, due to a likely combination of hormonal changes as well as new hand positions while holding or nursing a baby.
o Pain over the radial side of the wrist
o Pain extending up into the forearm either at rest of with movement of the thumb or wrist.
o Redness or swelling over the radial side of the wrist (can look like cellulitis)
o Diagnosis is “confirmed” by a positive Finkelstein’s test (see link below)
§ Have the patient makes a fist with the fingers clasped over the thumb.
§ The wrist is then bent in the direction of the little finger
o Thumb Spica splint
o Oral anti-inflammatory medication
o Cortisone injection into the region of the tendon
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions