De Quervain’s Tenosynovities

8/4/2019 De Quervains Tenosynovities

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Dr .Ankit Gujarathi

Resident

DMH,Pune


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(GRAYS TEXT BOOK)


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Bones Ha co sist of 27

bo es:

14 ala geal bo es 5 etacarpal bo es

8 Carpal bo es Carpal bo es are ma e p

of two rows of fo r bo esbri ge by flexorreti ac l m w ic formst e carpal t el.


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Ant compartment of hand


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Handy Thenar group-

-ab ctor pollicis brevis

-flexor pollicis brevis-oppo e s pollicis

-a ctor pollicis(ul ar erve)

y Hypothenar group-

-palmaris brevis-ab uctor igiti mi imi

-flexor igiti mi imi

-oppo e s igiti mi imi

4 lumbricals4 palmar i terossei

4 orsal i terossei


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Flexor group- Flexor carpi ra ialis

- Flexor carpi ul aris

- Palmaris lo gus (sometimes abse t)- Pro ator teres

- Flexor igitorum superficialis

- Flexor igitorum profundus

- Flexor pollicis longus


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Median n. Flexor digitorum superficialis and flexor digitorum profundus

enclosed bycommon flexor sheath Flexor pollicus longus enclosed bytendinous sheath of

flexor pollicus longus


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Post compartment of handy The extensor tendons

gain entrance to the

hand from the forearmthrough a series of sixcanals, fivefibroosseous and onefibrous.


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tendons of abductor pollicis longus and extensor pollicis brevis tendons of extensor carpi radialis longus and brevis

tendon of pollicis longus

tendons of extensor digitorum, extensor indicis

tendon of extensor digiti minimi

tendon of extensor carpi ulnaris


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Extensor groupy Superficial-

-anconeus

-brac ioradialis-ext carpi radialis longus

-ext carpi radialis brevis

-ext digitorum

-ext digiti minimi

-ext carpi ulnaris

y Deep-

-supinator

-abductor pollicis longus-ext pollicis brevis

-ext pollicis longus

-ext indicis


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Extensor retinaculum T ic ening ofdeep

fascia of forearm a wrist

Attac ed laterally toradius and medially tostyloid process ofulnaand triquetrum

Forms six fibrous

compartments forextensor tendonspassing from forearminto and.


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Causey Idiopat ic

y Overuse injuries

y Blac berry t umb

y Associatedwit RA

Swiss ysici -D Q r i(1895)


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Path


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What it is?y Stenosing tenosynovitis of the abductor pollicis

longus and extensor pollicis brevis tendons.

ySmall compartment

y Myxoid degeneration of tendon


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Symptomsy Pain

y Tenderness

y Swellingy ifficulty in gripping


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DiagnosisFinkelstein test Eichoff test


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D/Dy OAof 1st carpo-metacarpal joint

(above test ve)

y Intersection syndrome-

y Wartenbergs syndrome


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Treatmenty Conservative treatment

- rest on a splint

-the injection of a steroid preparation

y Surgery

First6 wee s


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Thumb-spica splint.


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Local steroid

-Met ylprednisolone 40 mg/triamcilone 40mg + lingocaine 1%-Maximally abduct t umb (accentuates abductor tendon)-Aim 30-45 degrees proximally toward radial styloid

-max two repetition in 7 days


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Surgeryy 6 w from onset of symptoms

(Harvey et al 1975)

-local anest etic agent-tourniquet

-P and

-Incisiondorsal to volar oblique or longitudinal


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Superficial radial nerve


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Opening sheath


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? Surgery failurey (1) formation of a neuroma in a severed branch of

the superficial radial nerve.

y

(2) volar subluxation of the tendon when toomuch of the sheath is removed.

y (3) failure to find and release a separate aberranttendon within a separate compartment.

y (4) hypertrophyof scar from a longitudinal skinincision.


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Surgical modifications-

to avoid subluxationy McMahon et al

(distally based slip of brac ioradialis tendon)

y Ramesh and Britton(used t e extensor retinaculum )

y Wilson et al

(Distally based radial forearm fascia-fat flap)

y Littler, Freedman, and Malerich

(reconstruction of first extensor compartment )


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Take home message

-wait for 6 w s

-2 max trial of local steroids

-don't operate immediately

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De Quervain’s Tenosynovities