It is generally felt that repetitious type activities contribute to the development of extensor tenosynovitis. Just as the etiology for trigger finger/thumb is often unclear, the etiology for De Quervain’s tenosynovitis is also often unclear. The name De Quervain’s tenosynovitis is attributed to the Swiss surgeon who first described the condition approximately one century ago. Any of the compartments can be involved in stenosis tenosynovitis however, the first extensor compartment containing two tendons to the thumb is by far the most commonly involved extensor tendon compartment. These tendons pass through six compartments on the dorsum or back of the wrist. The muscles on the back of the forearm are connected to the wrist and fingers by long ropes (tendons). The outcomes are usually quite positive with complications being unusual.ĭe Quervain’s stenosing tenosynovitis is tendinitis of the first extensor compartment. This generally allows the tendon to glide smoothly and restores the function of the hand. The neurovascular structures can be protected, and the proximal portion of the tendon sheath can be released. This type of surgery is carried out in an outpatient facility, often under local anesthesia through a small incision. Those patients who have persistent symptoms despite nonsurgical treatment may be indicated for a trigger finger/thumb release. The majority of patients will respond to non-operative measures. Nonsurgical treatment includes rest, splinting, NSAIDs, work modification where appropriate, and occasional corticosteroid injections into the tendon sheath. Treatment includes non-operative and operative modalities. Treatment of trigger finger/trigger thumb: X-rays are often necessary to rule out underlying arthritis or traumatic conditions, and occasional laboratory studies will be ordered to rule out underlying systemic disease. The diagnosis is made with a careful history of the patient’s symptoms, a physical exam of the hand and upper extremity which may demonstrate tenderness, triggering, or a locked digit. Often this is worse in the morning, and symptoms can worsen during the day with repetitious use of the hands. This may be intermittent, and the patients may develop snapping or catching. The patients often have pain on the palmar aspect of the thumb and fingers. Some medical conditions such as rheumatoid arthritis and diabetes can be associated with an increased risk of trigger finger/thumb, and local trauma may be a precipitating cause, but often the etiology is unclear. This may lead to pain, catching or triggering, or the thumb or finger becoming stuck in a flexed or extended position. In stenosing tenosynovitis, the tendon sheath thickens, there may be inflammation of the tendon, and the tendons fail to glide through the tendon sheath in a smooth and painless fashion. The tendon sheath holds the tendons against the bone and adds mechanical advantage for the flexion of the thumb and fingers. The thumb has one flexor tendon, and each finger has two flexor tendons. Think of it as a rope going through a hose. When these tendons pass out into the thumb and fingers, they run through a tendon sheath or tube. The muscles on the palmar side of the forearm are connected to the fingers by long tendons or ropes. What is trigger finger/trigger thumb or stenosing tenosynovitis? The first is trigger finger/trigger thumb (stenosing tenosynovitis), and the second is De Quervain’s disease, or extensor tenosynovitis. There are two common causes of hand pain which are seen on a frequent basis. Hand pain can be the result of trauma, arthritis, nerve compression, infections, tumors, and skin/circulatory disorders. This is an extremely broad topic which includes many conditions. John Zebrack, MD General Orthopedic Surgery Jeffrey Webster, MD General Orthopedic Surgery Nichole Joslyn, MD Hand & Upper Extremity Thomas Christensen, MD Hand & Upper Extremity James Christensen, MD Hand & Upper Extremity Nikola Babovic, MD Hand & Upper Extremity
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