- is a stenosing tenosynovial inflammation of the 1st dorsal compartment.
- Diagnosis is made clinically with radial sided wrist pain made worse with the Finkelstein maneuver.
- Treatment is generally conservative with thumb spica braces, injections and in refractory cases, 1st dorsal compartment surgical release.
- Incidence – very common, ~1 per 1000 annually, woman > men, 30 – 50 years old
- most commonly in the dominant wrist
- Risk factors
- overuse
- golfers and racquet sports
- post-traumatic
- postpartum
- Symptoms
- gradual onset – radial sided wrist pain
- pain exacerbated by gripping and raising objects with wrist in neutral
- Physical exam
- Inspection – tenderness over 1st dorsal compartment at level of radial styloid
- usually normal wrist motion
- pain with resisted radial deviation
- Finkelstein maneuver
- On grasping the patient’s thumb and quickly abducting the hand ulnarward, the pain over the styloid tip is painful
- more indicative of EPB > APL tendon pathology
- Imaging
- Xray – may be used to rule out basilar arthritis of the thumb, carpal arthritis
- Differential
- Thumb CMC arthritis
- Intersection syndrome
- FCR tendinitis
- Treatment
- Nonoperative
- rest, NSAIDS, thumb spica splint, steroid injection
- NSAIDS, rest and immobilisation usually first step
- steroid injections into first dorsal compartment usually second step
- overall corticosteriods found to be superior to splinting
- Operative
- surgical release of 1st dorsal compartment
- usually consider after 6 months of failed nonoperative management
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