of developing tendinitis of the hand and wrist: perform (Dupuis, 1986; Hagberg et al., 1995). The rigidity of the
ing highly repetitive work increases the relative risk of structures and limited space within the wrist compartment
developing De Quervains tenosynovitis to 3.3, while favour the development of tenosynovitis.
performing work requiring the exertion of great force
increases it to 6.1. Among individuals performing work
that is both highly repetitive and forceful, the relative risk
is 29 (Hagberg et al., 1995).
1
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Figure 1.1
Insertion and Action of the Tendons of the Extensor Pollicis Brevis
and Abductor Pollicis Longus
Tenosynovitis may result from trauma or from and stenosis increases. In the final stages, the sheath of
excessive friction between the tendon and surrounding the first dorsal compartment thickens, becomes fibrous,
tissues during movements of the thumb and wrist. The and impinges on the space of the fibro-osseous groove.
thickness of the synovial membranes is an indication of This may result in trigger finger, a chronic form of De
the stage of the tendinitis. As the inflammation progresses, Quervains tenosynovitis.
the tendon tends to thin out and become more friable,
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Tenosynovitis affecting the dorsal tendons of the movements requiring a pinch grip and frequent hand
wrist may be of two types: movements with the wrist flexed and thumb abducted
generate great strain on the tendons of the abductor
Tenosynovitisis with effusion is of infectious or pollicis longus and extensor pollicis brevis.
rheumatoid origin. In the latter case, it is indicative
of rheumatoid arthritis and may presage polyarthritis Finally, factors such as the use of gloves and exposure
(Dupuis, 1986). to cold or vibration increase the risk of developing this
De Quervains tenosynovitis is one of the most condition. Box 2.1 illustrates the movements frequently
common forms of the stenosing tenosynovitises, 3
associated with De Quervains tenosynovitis.
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Box 2.1
Cofactors
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thumb carpometacarpal
osteoArthrosis
Clinical Presentation
Osteoarthrosis of the trapezometacarpal joint and usually
affects women aged 50-70 years (Figure 3.1). It is
accompanied by local deformity, crepitation, and pain of
variable intensity that is unrelated toradiological changes
(Dupuis, 1986).
Probable causes
trauma
age- and sex-related factors
Diagnostic Test
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Probable Causes
repetitive finger-pinch prehension while flexing and
extending the wrist or supinating the forearm
direct trauma
Diagnostic Test
Palpation will reveal a painful area and crepitation with
swelling on the radial side approximately three
finger-widths above the wrist (Pujol, 1993).
Wartenbergs Syndrome
This syndrome is caused by compression of the distal
Figure 3.3
sensory branch of the radial nerve (Figure 3.3).
Test for Wartenbergs Syndrome Clinical Presentation
pain or numbness over the distal third of the forearm,
increased by ulnar deviation
discomfort while writing
discomfort while grasping objects or using a pinch
grip
Possible Causes of Compression
external trauma, falls, twisting of the forearm
repetitive or forceful pronation
compression by a bracelet or watch
compression by soft-tissue disorders (synovial cyst,
Copyright 1998. Editions MultiMondes. All rights reserved.
Diagnostic Tests
Symptoms may be elicited by applying pressure over an
area two finger-widths wide proximal to the radial styloid
process while the patient maintains the forearm pronated
6
and the wrist in ulnar deviation (Figure 3.3). The test is
considered positive if symptoms occur in less than one
minute. Finkelsteins test may also be positive (See
Figure 6.4, page 18).
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Clinical Presentation
Resisted elbow flexion* and application of pressure on
the radial styloid process both elicit pain over the radial
styloid process.
Probable Causes
Performing repeated finger-pinch prehensions with
the wrist supinated or extended
Diagnostic Test
Resisted movement of the brachioradialis elicits pain at
its insertion on the radial styloid process (Figure 3.4).
Clinical Presentation
Pain is present on the radial side of the dorsal aspect of
the wrist, and may be accompanied by swelling.
Figure 3.5
Probable Causes Test of the Extensor Digitorum Communis
Extension movements
Sustained static pronation associated with grasping of
objects
Diagnostic Test
Resisted extension elicits the symptoms and indicates the
presence of tendinitis of the extensor digitorum
communis (Figure 3.5).
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DE QUERVAINS TENOSYNOVITIS
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Box 4.1
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Box 4.2
Box 4.3
10
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Tendinitis of the hand and wristsuch as De Quervains to characterise the occupational, sports-related, and
tenosynovitishas been reported to be associated with household activities that may have contributed to the
forceful or repetitive occupational activities, with the risk development of tendinitis or tenosynovitis.
of developing tendinitis significantly increased when
exposure is to activities that are both forceful and Previous Work
repetitive (Hagberg et al., 1995). Information on The patients occupational history provides information
environmental cofactors such as exposure to cold and on the extent of previous exposure to work-related
vibration should also be gathered. musculoskeletal strain of the upper limb.
Occupational History
To establish that a case of De Quervains tenosynovitis
is caused by biomechanical requirements it is necessary
Box 5.1
11
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Current Work
The description of current work should allow the evaluate the contribution of organisational factors
physician to form a good idea of the patients work and (Box 5.4)
the conditions under which it is performed. As it is
There is a wide range of repetitive occupational
generally difficult for physicians to visit the workplace,
activities. Box 5.3 lists common activities which are related
this guide presents series of questions designed to help
to the development of De Quervains tenosynovitis. If
them:
there is little or no correspondence between the patients
obtain accurate information on the general nature of activities and those listed, a useful strategy may be to ask
the work (Box 5.2) her or him to describe working activities or movements
determine the presence of specific biomechanical and evaluate their biomechanical characteristics (duration,
requirements which favour the development of De frequency and force).
Quervains tenosynovitis (Boxes 5.3 and 5.5)
Box 5.2
12
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Other (describe)
Comments
13
DE QUERVAINS TENOSYNOVITIS
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Box 5.4
Comments
Copyright 1998. Editions MultiMondes. All rights reserved.
14
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Box 5.5
15
DE QUERVAINS TENOSYNOVITIS
Rossignol, Michel. De Quervain s tenosynovitis [Internet]. Qubec City: Editions MultiMondes; 1998. [cited 2017 August 13]. Available from: ProQuest Ebook Central
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