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Orthopaedics

Common wrist injury Quervains Tenosynovitis


Quervain’s Tenosynovitis

The condition called de quervains tenosynovitis causes pain on the inside of the wrist and forearm just above the thump.

  • It is the inflammation of the fluid filled sheath that surrounds a tendon
  • This is the common problem effecting the wrist and usually easy to diagnose
  • Tendons connect muscle to the born and the muscles pull on tendons for movements.
  • The muscles connected to anterior posterior ligaments and extensor pollicis brevis tendons are on the back of the forearm.
  • APL & EPB (Refer above for the abbrev) tendons travel inside edge of the wrist.
  • They pass through a tunnel near the end of the forearm.
  • This tunnel is lined with a slippery coating called tenosynovium
  • The inflammation of the tenosynovium and tendon is called tenosynovitis
  • In this condition the inflammation constricts the movement of the tendons within the tunnel.

Causes:

  • Repeated thump motions such as  grasping, pinching, squeezing
  • Arthritis or injury
  • Introduction of bacteria into a sheath through a small penetrating wound such as that made by the point of needle or thorn.

Symptoms:

  • Soreness of thumb , side of the forearm and near the wrist.
  • The two tendons may move through the constricted tunnel. These causes noise while moving hand called crepitus.
  • Pain and swelling
  • Difficulty in moving joint.

Diagnosis:

Flnklestein test

  • Bend your thumb into your palm
  • Grasp the thumb with in your fingers making a fist.
  • Bend your wrist away from your thumb
  • If you feel pain over the tendons to the thumb the test is positive.

Physical examination shows swelling

Stretching tendon to check whether there is pain.


Treatments:

  1. Stop all activities that causes your symptoms
  2. Take break when doing repeated hand and thumb movements
  3. Avoid grasping , wringing or turning and twisting movements of the wrist.
  4. After injury is evaluated wear a special forearm and thumb splint called a thumb – spica spint.
  5. Use Anti inflammation drugs
  6. Stretching and strengthening exercise to wrist and forearm.


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