DeQuervains Tenosynovitis

Carpal Tunnel Master And Beyond

Foods to eat when you have Carpal Tunnel Syndrome

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DeQuervain's tenosynovitis is a painful repetitive and overuse condition of the abductor pollicis longus and extensor pollicis brevis along the dorsal radial aspect of the wrist. Patients present due to pain and swelling along the dorsal radial side of the wrist, which is worsened with activities. Physical examination reveals tenderness with palpation, and the classic clinical finding is a positive Finkelstein test. This is performed by having the patient flex and adduct the thumb to the palm, then close the remaining fingers over the thumb. The examiner then passively takes the patient's wrist into ulnar deviation. Pain along the tendons with this

Figure 30-18 Cross-sectional anatomy of the carpal tunnel, bounded on three sides by the carpal bones and volarly by the transverse carpal ligament. Nine flexor tendons and the median nerve pass through the tunnel. Anything that causes increased pressure in this canal can produce the symptoms of carpal tunnel syndrome.

(From McCue FC, Bruce VF: Hand and wrist. In Delee JC, Drez D [eds]. Orthopedic Sports Medicine: Principles and Practice, vol I. Philadelphia, Saunders, 1994, p 997.)

Figure 30-18 Cross-sectional anatomy of the carpal tunnel, bounded on three sides by the carpal bones and volarly by the transverse carpal ligament. Nine flexor tendons and the median nerve pass through the tunnel. Anything that causes increased pressure in this canal can produce the symptoms of carpal tunnel syndrome.

(From McCue FC, Bruce VF: Hand and wrist. In Delee JC, Drez D [eds]. Orthopedic Sports Medicine: Principles and Practice, vol I. Philadelphia, Saunders, 1994, p 997.)

Starting position 1

Position 2

Position 3

Wrist in neutral, fingers and thumb in flexion

Wrist in neutral, fingers and thumb extended

Thumb in neutral, wrist and fingers extended

Position 4

Position 5

Position 6

Wrist, fingers and thumb extended

Same as in position 4, with forearm in supination (palm up)

Figure 30-19 Carpal tunnel nerve glide exercises.

Same as in position 5, other hand gently stretching thumb

Flexor Tendon Nodule
Figure 30-20 Flexor tendon nodule.

maneuver is considered a positive test (Finkelstein, 1930). Radiographic tests are not necessary to make an accurate diagnosis.

Treatment begins with avoidance of the inciting activities. Ice may reduce pain and swelling, and analgesic medications are often used as well. Thumb spica splinting is very helpful, allowing the irritated tendons to rest (Winzeler and Rosenstein, 1996). Prolonged splinting may be needed to reduce pain significantly. Corticosteroid injection along the tendon sheath is often used to reduce pain more acutely (Peters-Veluthamaningal et al., 2009a; Wood and Dobyns, 1986). In refractory cases, surgical decompression of the tendons can be performed.

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