De Quervain’s Syndrome

Miss Meg BirksConsultant Hand Surgeon

GP Education event 1st March 2012

Presentation – symptoms

• Radial Sided wrist pain

• Difficulty with everyday activities– Writing/typing– Opening bottles/jars– Using scissors

Presentation - signs

• Swelling and tenderness over the tendons

• Finklestein’s test positive

Differential Diagnosis

• OA base of thumb• STT joint OA• Scaphoid pathology• Carpal tunnel syndrome

Further Information

Injection technique• Position the wrist

on table, thumb side up

• Palpate the radial styloid

• Approach from distal (hand end) at 45°

Injection technique

• Insert needle to bone and then withdraw a few millimetres

• Inject – hope to see a “sausage” of fluid form

• Reposition needle (same entry point) if strong resistance

Possible complications

• Irritation of superficial radial nerve• De pigmentation of skin• Fat atrophy• Failure to improve

– Consider confirming the diagnosis with USS

Any Questions?