CC May 2016 de Quervain Tenosynovitis

echoecho's version from 2016-09-07 03:15


Question Answer
What is the pathophysiology of de Quervain tenosynovitis (dQT)?Affects tendons of abductor pollicis longus and extensor pollicis brevis muscles as they pass through the tendon sheath in the first dorsal compartment of the wrist
Is dQT a true inflammatory condition?no, rather, the tendon sheath undergoes degeneration and thickening, increasing friction as the tendon slides through it
Some recent studies have found inflammatory mediates in tissue specimens, name these?1) neutrophil elastase 2) interleukins 3) cycloxygenase
The inflammatory mediators may be _______ rather than primary etiologic factors?secondary
While this condition is attributed occasionally to a specific trauma, in most cases it is thought to be due to what?overuse injury from activities like knitting, typing or lifting
Repetitive use of hand-held electronic devices have been implicated, true or false?true
People between the age of ____ and _____ years are most likely to present with this condition? Which gender is affected more, with some saying a 10-fold higher risk in this gender?35;55;women
Pregnancy and post-partum period are frequently noted and attributed to hormonal effects on what?connective tissues, edema and repetitive hand activities associated with childcare
What does physical exam reveal?tendernress and mild swelling over the radial styloid (which may be accompanied by erythema and or a palpable sense of friction on extension of the thumb
What is the classical physical exam maneuver to dx dQT?positive Finkelstein's test
Describe the positive Finkelstein's test?have patient form a first with the fingers encircling a flexed thumb. Passive ulnar deviation of the wrist produces pain over the radial styloid.
What is the "grind test"?it is axial loading with internal and external rotation of the first carpo-metacarpal joint and utilized to dx carpo-metacarpal joint arthritis
*** Based on limited evidence from few, small randomized trials, what appears to be the single most effective treatment for dQT?corticosteroid injection
*** Recently, the combined benefit of what two modalities was demonstrated to be greater than either modality alone in a systematic review?1) hand orthosis 2) corticosteroid injection
The success of corticosteroid injection requires what?injection of steroid into the tendon sheat
in 50% of patients with dQT, what can be found, possibly limiting the effectiveness of a single injection?a septation creating seperate compartments for the 2 tendons (abductor pollicis longus and extensor pollicis brevis tendons which are often contained in a single sheath)
In those 50% of dQT patients with a septation, what technique may be more effective than clinical injection?ultrasound-guided injections
What treatment can be done for patients with persistent symptoms?surgical release of the first extensor compartment
*** SUMMARY = What is dQT?a questionably inflammatory, painful disorder of the sheath of the abductor pollis longus and extensor pollicis brevis tendons as they travel through the first dorsal compartment of the wrist
*** SUMMARY = dQT is commonly associated with what activities?repetitive thumb activities
*** SUMMARY = There is a greater incidence in what gender and in what two medical conditions which would increase susceptibility?1) women 2) pregnancy 3) postpartum
*** SUMMARY = What is the treatment?1) rest 2) immobilization 3) NSAIDS 4) corticosteroid injections 5) surgical intervention (reserved for refractory cases)