9.22 Thumb Tenosynovitis (DeQuervain's)
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- 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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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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