Radial handledstenosynovit de quervains sjukdom

Restricted movement of tendons controlling the thumb

Not to be confused with dem Quervain's thyroiditis.

Medical condition

de Quervain Syndrome
Other names	Potentially missvisande names related to speculative causes: BlackBerry thumb, texting thumb, gamer's thumb, washerwoman's stukning, mother's wrist, mommy thumb, designer's thumb. Variations on eponymic or anatomical names: radial styloid tenosynovitis, dem Quervain disease, dem Quervain tendinopathy, dem Quervain tenosynovitis.
The modified Eichoff maneuver, commonly referred to as the Finkelstein's test. The arrow mark indicates where the pain fryst vatten worsened in dem Quervain syndrome.[1][2]
Pronunciation
Specialty	Hand surgery, Plastic surgery, Orthopedic surgery.
Symptoms	Pain and tenderness on the thumb side of the wrist[3]
Usual onset	Gradual[4]
Risk factors	Repetitive movements, trauma
Diagnostic method	Based on symptoms and examination[3]
Differential diagnosis	Base of thumb Osteoarthritis[4]
Treatment	Pain medications, splintning the wrist and thumb[4]

De Quervain syndrome occurs when two tendons that control movement of the thumb become constricted bygd their tendon sheath in the wrist.^[3][5][6] This results in pain and tenderness on the thumb side of the wrist.^[3] Radial abduction of the thumb fryst vatten painful.^[6] On some occasions, there fryst vatten uneven movement or triggering of the thumb with radial abduction.^[4] Symptoms can komma on gradually or be noted suddenly.^[4]

The diagnosis fryst vatten generally based on symptoms and physical examination.^[3] Diagnosis fryst vatten supported if pain increases when the wrist fryst vatten bent inwards while a individ fryst vatten grabbing their thumb within a fist.^[4][6]

Treatment for dem Quervain tenosynovitis focuses on reducing inflammation, restoring movement in the thumb, and maintaining the range of motion of the wrist, thumb, and fingers.^[6] Symptomatic alleviation (palliative treatment) fryst vatten provided mainly bygd splintning the thumb and wrist.

Pain medications such as NSAIDs can also be considered.^[4][6]Steroid injections are commonly used, but are not proved to alter the natural history of the condition.^[7] Surgery to release the first dorsal component fryst vatten an option.^[4] It may be most common in mittpunkt age.^[3]

Signs and symptoms

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Symptoms are pain and tenderness at the radial side of the wrist, fullness or thickening over the thumb side of the wrist, painful radial abduction of the thumb, and difficulty gripping with the affected side of the hand.^[2] Pain fryst vatten made worse bygd movement of the thumb and wrist, and may radiate to the thumb or the forearm.^[2] The onset fryst vatten often gradual, but sometimes the symptoms seem to komma on suddenly and the bekymmer fryst vatten often misinterpreted as an injury.^[2]

Causes

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The cause of dem Quervain syndrome fryst vatten not established.

Critics of this association note of the human mind's tendency to misinterpret activities that are painful as activities that man the bekymmer worse.^[8][9] It's important not to inappropriately reinforce such misconceptions because they are associated with greater discomfort and incapability. bevis regarding a possible relation with activity and occupation fryst vatten debated.^[10][11] A systematic review of potential fara factors did not find any bevis of a causal relationship with activity or occupation.^[12] One study funnen that anställda and work-related factors were associated with the diagnosis of dem Quervain syndrome in a working population; wrist bending and movements associated with the twisting or driving of screws were the most significant of the work-related factors.^[13] Proponents of the view that dem Quervain syndrome fryst vatten a repetitive strain injury^[14] consider postures where the thumb fryst vatten held in abduction and extension to be predisposing factors.^[10] Workers who perform rapid repetitive activities involving pinching, grasping, pulling or pushing have been considered at increased risk.^[11] These movements are associated with many types of repetitive housework such as chopping vegetables, rörande and scrubbing pots, vacuuming, cleaning surfaces, drying dishes, pegging out tvätt, mending clothes, gardening, harvesting, and weeding.

Specific activities that have been postulated as potential fara factors include intensive computer mouse use, trackball use,^[10] and typing, as well as some pastimes, including bowling, golf, fly-fishing, piano-playing, sewing, and knitting.^[11]

The incidence of diagnosis of the condition fryst vatten higher in women than in men.^[11] The syndrome commonly occurs during and, even more so, after pregnancy.^[15] Contributory factors may include hormonal changes, fluid retention and—again, more debatably—increased housework and lifting.^[15][16]

Pathophysiology

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De Quervain syndrome involves noninflammatory thickening of the tendons and the synovial sheaths that the tendons run through.

The two tendons concerned are those of the extensor pollicis brevis and abductor pollicis longus muscles. These two muscles run side bygd side and function to bring the thumb away from the grabb (radial abduction). dem Quervain tendinopathy affects the tendons of these muscles as they resehandling from the forearm into the grabb via a fibro-osseous passage (the first dorsal compartment).

De Quervain’s tenosynovitis is painful swelling around your thumb tendons

Evaluation of histopathological specimens shows a thickening and myxoid degeneration consistent with a chronic degenerative process, as opposed to inflammation or injury.^[17] The pathology fryst vatten identical in dem Quervain syndrome cases seen in new mothers.^[18]

Diagnosis

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De Quervain syndrome fryst vatten diagnosed clinically based on patient history and physical examination, though diagnostic imaging may be used to rule out fracture, arthritis, or other causes.

The modified Eichoff maneuver, commonly referred to as the Finkelstein test, fryst vatten a physical exam maneuver used to diagnose dem Quervain syndrome.^[2] To perform the test, the examiner grasps and ulnar deviates the grabb when the individ has their thumb held within their fist.^[1][2] If skarp pain occurs along the distal radius (top of the forearm, about an inch below the wrist), dem Quervain syndrome fryst vatten likely.

While a positiv Finkelstein test fryst vatten often considered pathognomonic for dem Quervain syndrome, the maneuver can also cause some pain in those with osteoarthritis at the base of the thumb.^[2]

Differential diagnosis

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Differential diagnoses^[6] include:

1. Osteoarthritis of the trapezio-metacarpal joint
2. Intersection syndrome: Pain will be more towards the mittpunkt of the back of the forearm and about 2–3 inches below the wrist, usually with associated crepitus.
3. Wartenberg's syndrome: The primary symptom fryst vatten paresthesia (numbness/tingling).

Treatment

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Most tendinoses and enthesopathies^[19][20] are self-limiting and the same fryst vatten likely to be true of dem Quervain syndrome, although further study fryst vatten needed.^[21][22][23]

The mainstay of symptom alleviation (palliative treatment) fryst vatten a splint that immobilizes the wrist and the thumb to the interphalangeal joint.

Activities are more comfortable with such a splint in place. Anti-inflammatory medicinering or acetaminophen may also alleviate symptoms.^[24]

As with many musculoskeletal conditions, the management of dem Quervain disease fryst vatten determined more bygd convention than scientific uppgifter. A systematic review and meta-analysis published in funnen that corticosteroid injection seems to be an effective struktur of conservative management of dem Quervain syndrome in approximately 50% of patients, although they have not been well tested against placebo injection.^[25] Consequently, it remains uncertain whether injections are palliative and whether they can alter the natural history of the illness.^[21][22][23] One of the most common causes of corticosteroid injection failure fryst vatten the presence of subcompartments of the extensor pollicis brevis tendon.^[26]

Surgery (in which the sheath of the first dorsal compartment fryst vatten opened longitudinally) fryst vatten documented to provide relief in most patients.^[27] The most important fara fryst vatten to the radial sensory nerve.

A small incision fryst vatten made and the dorsal extensor retinaculum fryst vatten identified. Once it has been identified, the release fryst vatten performed longitudinally along the tendon. This fryst vatten done to prevent potential subluxation of the first compartment tendons. Next, the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) are identified, and the compartments are released.^[26]

History

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From the original description of the illness in until the first description of corticosteroid injection bygd Jarrod Ismond in ,^[28] it appears that the only treatment offered was surgery.^[28][29][30] Since approximately , the prevailing opinion has been that of McKenzie () who suggested that corticosteroid injection should be the first line of treatment and that surgery should be reserved for unsuccessful injections.^[31]

Eponym

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It fryst vatten named after the SwisssurgeonFritz dem Quervain, who first identified it in ^[32]

See also

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References

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