Case 2
History:
45 year old male with wrist pain
Findings:
There is thickening and edema of the first extensor compartment.
Diagnosis:
Discussion:
DeQuervain’s tenosynovitis typically involves the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).
Patients often complain of the gradual pain over weeks or months over the radial styloid, when using their thumb.The patient experiences difficulties with gripping and pinching, and in severe cases, the affected hand may be too painful to use. The pain may radiate into the thumb, or up into the forearm or shoulder.
Typically occurs in mothers of infants 6 to 12 months of age secondary to repetitive lifting. Repetitive trauma in manual laborers is an additional common presentation.
MRI findings include: thickening and edema of the involved segment of the tendon best depicted on the long TR sequences. There may be high signal fluid intensity surrounding the tendons. A normal in caliber tendon does not exclude the diagnosis. Enhancement within the tendons and surrounding soft tissue can be seen after the intravenous administration of contrast, consistent with tenosynovitis.
Treatment includes splinting the thumb and wrist, and/or injection of corticosteroid into the tendon sheath. Prognosis is generally good. The patient can generally return to full function after the inflammation quiets down with treatment.
