9.22 Thumb Tenosynovitis (DeQuervain’s)

agk’s Library of Common Simple Emergencies

Presentation

The patient, usually a middle-aged woman, has difficulty with tasks like opening jars because of pain at the base of the thumb, which may also be present upon awakening. On examination, there is little or no swelling and no deformity, just tenderness on palpating or stretching the extensor pollicis brevis and abductor pollicis longus tendons bordering the palmar side, or less commonly, the extensor pollicis longus tendon bordering the dorsal side of the anatomic snuffbox.

What to do:

• Document normal circulation, sensation, movement. Compress the thumb metacarpal onto the scaphoid to see if it is fractured. Look for carpal tunnel syndrome with Phalen’s test.
• Have the patient fold the thumb into the palm, close the fingers over it into a fist, then ulnar deviate the wrist. This is known as the Finklestein test, and reproduces the pain of DeQuervain’s tenosynovitis of the extensor pollicis brevis and abductor pollicis longus tendons.
• Presecibe anti-inflammatory analgesics and a radial gutter splint to immobilize the thumb to the intraphalangeal joint.
• Arrange for rehabilitation.

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