A 43 y.o. cook presents with severe wrist pain
What is your differential?
Our patient had de Quervain’s tenosynovitis. This is an extremely painful condition affecting the tendons in the first dorsal compartment of the wrist.A nodule may develop over the tendon sheath at the wrist from inflammation.
A tender nodule on the wrist may be a clue to the diagnosis
De Quervain’s is associated with repetitive movements of the hand and wrist like playing video games, slicing vegetables repeatedly, or picking up a baby. The lay term for de Quervain’s is mommy’s thumb because it is common in new mothers. It can result from carrying a baby (along with fluid retention resulting from lactational changes). It usually occurs when the infant is about 8 months old.
the finkelstein test
A BRIEF DIFFERENTIAL DIAGNOSIS OF WRIST PAIN
Trauma- There are many causes of traumatic wrist pain including : trauma with scaphoid fractures or scapholunate dissociation.
Infection- This is not to be missed because it can lead to permanent joint destruction. A sed rate and CRP and US to rule out joint fluid are helpful. Gonococcal infection can present in the wrist. Gout frequently mimics a septic joint.
Systemic causes-Gout, pseudogout, rheumatoid arthritis and amyloid can all cause pain at the wrist.
Neurologic causes- Ulnar , median and radial nerve entrapment can all cause pain at the wrist.
the diagnosis can be made on US if there is fluid around the tendons and none in the joint
Our patient had labs drawn to rule out a septic joint, and a negative xray. She had a thumb spica created so she could continue to pinch her knife by flexing the index finger. She was given voltaren and follow up with plastics for tendon injection.
Spicer P, Thompson H, Montgomery J. Mommy’s thumb: De Quervain’s tenosynovitis in a new mother with cardiomyopathy. Radial Case Rep 2022 Nov;17(11)::4368-4370.
Shehab R, Mirabelli M. Evaluation and diagnosis of wrist pain: a case-based approach American Family Physician 2013;87(8):568-573.
Reinstein L. De Quervain’s stenosing tenosynovitis in a video games player. Case Reportsd Arch Phys Med Rehabil. 1983 Sep;64(9):434-5.