TENOSYNOVITIS OF THE HAND AND WRIST A Critical Analysis Review

Trigger Finger Trigger finger is common in patients with diabetes. Corticosteroid injections are effective in about 60% to 92% of cases. Proximal interphalangeal joint contracture may occur in long-standing cases. The outcomes of open and percutaneous releases are similar; however, surgeons are split on preferences. Intersection Syndrome The classic finding is crepitus with wrist motion at the distal one-third of the radial aspect of the forearm. Extensor Pollicis Longus (EPL) Tenosynovitis Corticosteroid injections should be used with caution because of the potential for rupture. EPL tenosynovitis is very rare. de Quervain Disorder This condition is common in postpartum women. A positive Finkelstein test is considered to be pathognomonic of de Quervain disorder, but care should be taken to differentiate this condition from thumb carpometacarpal arthritis. Corticosteroid injections are effective in about 80% of cases. Patients in whom corticosteroid injections fail to provide relief of symptoms frequently have a separate extensor pollicis brevis ( EPB) compartment. The abductor pollicis longus ( APL) tendon has multiple slips; care should be taken not to confuse one of these slips as the EPB. Traction on the APL pulls up the thumb metacarpal but not the thumb tip. Traction on the EPB extends the thumb metacarpophalangeal joint. Care should be taken to avoid injury to the sensory branch of the radial nerve. Fourth Compartment Tenosynovitis This uncommon condition is most often seen in patients with rheumatoid arthritis. The condition involves a large diffuse area, as opposed to the compact dorsal ganglion cyst.