Wrist Case Study 2 : De Quervains

Anatomy & Pathology

Inflamation or swelling of the sheath that surrounds 2 tendons which control
movement of the thumb – extensor pollicis brevis , abductor pollicis longus.
Cause unknown. Common – middle aged woman & overuse of thumb.

Subjective Examination
Where\What : expect pain, stiffness , some locking in thumb, swelling over radial
styloid

When:

How: expect writing – repeated use ( clerical)

0-10 rating:

24 hour cycle: expect no significant change

Better for: expect rest

Worse for: expect activity

Type of pain:

Past Medical History/ General History:

Red Flags and general concerns: swellinh over thumb joint may indicate arthritis of
thumb especially if there is pain on compression

SH: ask

DH: ask

Patients main outcome: ask

Objective Examination

Working Hypothesis: confirm de quervains

Advice & Consent: give and obtain

General Observations: - n/a

Acute Observations:
Skin colour - n/a
Swelling – around radial styloid – Around thumb joint => arthritis
Posture – n/a
Muscle bulk – expect atrophy around thumb
Deformity – check noby abnormality – although xrays should have ruled out
deformity

Active Tests / Passive Tests / Resisted Tests

Inferior radioulnar – pronation & spination
Radiocarpal – flexion extension radial deviation ulnar deviation
Carpometacarpal joint of thumb – flexion extension abduction adduction opposition
Metacarpal phalangeal joint – flexion extension adduction abduction
Proximal and distal phalangeal – flexion extension

In active – locking or sticking in abduction , creaking as tendons move

In Passive – swelling at radial styloid , deviation of radiocarapal – screen OA joint
problems at thumb – stiffness
In Resisted - test for muscle weakness , especially atrophy around thumb

Special Tests
Finkelstein – ulnar deviate fist

Functional Tests: expect difficulty gripping – dexterity tests

Palpation: expect tenderness over the tendons of the 1 st
dorsal compartment in
the region of the distal radius

Measurements:
Gripometer – difficulty in gripping – record when any active sticking in abduction
(start with thumb against index finger )

Advice & Possible Treatment:

Harmless nuisance ( tendon rupture is rare )

Self limited with no long term consequences once resolved it rarely recurs – illness
lasts about 1 year on average – no treatments.

Operative release – is the the only way to precitably shortenen the duration of
symptoms , but it is elective – pain resolves in time it takes to heal

Or it xan be managed with a pslica splint that immobilises wrist and thumn – anti
inflammatory NSAIDSs for pain ice can be used – but restricting use will not speed
up recovery – once pain free – exercise controlled ulnar deviation