Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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De Quervain’s Tenosynovitis

SYMPTOMS

There is localised, sometimes intense exercise-induced pain and swelling over the radial part of the wrist. This is common in racket sports.

AETIOLOGY

These symptoms are caused by compression of the abductor pollucis longus and extensor pollucis brevis by swollen, inflamed or hypertrophied tendon sheaths.

CLINICAL FINDINGS

There is tenderness on palpation over the radial part of the wrist and Finkelstein’s test is positive.

INVESTIGATIONS

Ultrasound investigation or MRI show para-tendinous fluid and occasionally two separate tendon sheaths. It is important to know this if surgery is required.

TREATMENT

NSAID and physiotherapy including partial immobilisation of the wrist with strapping or a brace, to block ulnar deviation of the wrist and thumb abduction. Cortisone injections are often suggested but their side-effects must be considered. Surgery for release of the tendon sheaths is indicated in severe or chronic cases.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon and hand specialist if there is long duration of progressive symptoms or if the diagnosis is not clear. Physiotherapy with partial immobilisation and training of hand muscle function is usually indicated.

EXERCISE PRESCRIPTION

Most sports can be maintained but avoid static dorsi-flexion such as holding a handlebar on a bicycle. Moreover, technical aspects that may be causing the problems must be addressed, such as the size of the racket handle. After surgery the symptoms are usually relieved almost immediately and most activities can be back to normal within six weeks. Running, cycling and water exercises (when the wound is healed after surgery) are good alternatives to keep up general fitness. Gym training can be maintained.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and negative Finkelstein’s test.

DIFFERENTIAL DIAGNOSES

This is a clear clinical diagnosis.

PROGNOSIS

Excellent, if treated appropriately. If it is missed, surgery can be performed at a later stage.

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