Tendonitis is a common wrist problem dealt with by physicians. Patients may present with pain and swelling of the involved tendons. History often reveals overuse as the inciting event, and patients report that the pain worsens with use of the inflamed tendon. Physical examination often reveals swelling and tenderness of the involved tendon. Radiographs are most often negative.
de Quervain's Disease de Quervain's disease involves a stenosing tenosynovitis of the first dorsal wrist compartment, which contains the abductor pol-licis longus and the extensor pollicis brevis. Patients often present with radial side wrist pain that is worsened with movement of the thumb. It is more common in the fourth and fifth decades and in females. Patients often report a history of repetitive activities involving thumb abduction and ulnar deviation of the wrist. On physical examination, Finkelstein's test will be positive (Fig. 40-9). This test is performed by fully adducting the thumb and then the wrist, which will reproduce the patient's pain. The differential diagnosis includes intersection syndrome and carpometacarpal arthritis. Patients with intersec-
tion syndrome report pain 4 cm proximal to the wrist joint. Patients with carpometacarpal arthritis may have evidence of arthritis on radiographs. Patients are treated conservatively with a combination of splinting, anti-inflammatory medications, and avoidance of the inciting activity. Corticosteroid injections can be used with 50% to 80% success. It has been shown that patients receiving an injection did not receive any additional benefit from splinting after the injection.15 The first dorsal compartment can be injected with 0.5 mL 1% lidocaine and 1 mL dexamethasone. When conservative measures fail, surgical release of the first dorsal compartment may be performed. A dorsal release of the compartment is performed. The abductor pollicis longus can often have multiple slips, and the extensor pollicis brevis may sometimes have its own subsheath so care must be taken to release all slips and subsheaths. Some authors report that surgical cases have an increased incidence of these minor anatomic differences. Care must be taken not to injure the radial sensory nerve. The patients are placed in a soft dressing for 10 to 14 days and then strengthening and range-of-motion exercises are begun.
Intersection syndrome is a stenosing tenosynovitis of the second extensor compartment. Patients often report radial side wrist pain 4 cm proximal to the wrist joint. This syndrome is often found in lifting and rowing athletes. On physical examination, an audible squeak may be heard and there may be palpable crepitus. Conservative management includes modifying activities, splinting in extension, anti-inflammatory medication, and corticosteroid injection of the second dorsal compartment. In cases that fail conservative management, surgical release of the second dorsal compartment can be performed, but this is rarely necessary.
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