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Diseases

Tenosynovitis of the hand and wrist

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Tenosynovitis of the hand and wrist includes trigger digits and de Quervain disease, which are the two most common forms of stenosing tenosynovitis.

  • Diagnosis is usually clinical.

  • If required, the single most useful and accurate investigation is a high-resolution ultrasound scan.

  • Treatment may involve splinting, corticosteroid/local anesthetic injections, nonsteroidal anti-inflammatory drugs (for some indications), or surgery.

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Tendons of the left hand

            Tendons of the left hand

          • Tendons of forefinger

            Tendons of forefinger

          • Tendons of the back of the wrist

            Tendons of the back of the wrist

          • Transverse section across the wrist

            Transverse section across the wrist

          Citations

            Key Articles

            • American College of Radiology. ACR-SABI-SPR-SSR practice parameter for the performance of magnetic resonance imaging (MRI) of the wrist. Aug 2023 [internet publication].[Full Text]

            • American College of Radiology. ACR-SPR-SSR practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the fingers and toes. 2023 [internet publication].[Full Text]

            • American College of Radiology. ACR-SPR-SSR practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of bone, joint, and soft tissue infections in the extremities. 2021 [internet publication].[Full Text]

            Referenced Articles

            • 1. Burman M. Stenosing tendovaginitis of the dorsal and volar compartments of the wrist. AMA Arch Surg. 1952 Nov;65(5):752-62.[Abstract]

            • 2. Lipscomb PR. Tenosynovitis of the hand and the wrist: carpal tunnel syndrome, de Quervain's disease, trigger digit. Clin Orthop. 1959;13:164-180.

            • 3. Patel MR, Bassini L. Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg Am. 1992 Jan;17(1):110-3.[Abstract]

            • 4. Quinnell RC. Conservative management of trigger finger. Practitioner 1980; 224:187-190.[Abstract]

            • 5. Harvey FJ, Harvey PM, Horsley MW. De Quervain's disease: surgical or nonsurgical treatment. J Hand Surg Am. 1990 Jan;15(1):83-7.[Abstract]

            • 6. Murphy D, Failla JM, Koniuch MP. Steroid versus placebo injection for trigger finger. J Hand Surg Am. 1995;20:628-631.[Abstract]

            • 7. Newport ML, Lane LB, Stuchin SA. Treatment of trigger finger by steroid injection. J Hand Surg Am. 1990;15:748-750.[Abstract]

            • 8. Rhoades CE, Gelberman RH, Manjarris JF. Stenosing tenosynovitis of the fingers and thumb: results of a prospective trial of steroid injection and splinting. Clin Orthop Relat Res. 1984;190:236-238. [Abstract]

            • 9. Stein AH Jr, Ramsey RH, Key JA. Stenosing tendovaginitis at the radial styloid process (de Quervain's disease). AMA Arch Surg. 1951;63:216-228.[Abstract]

            • 10. Fahey JJ, Bollinger JA. Trigger-finger in adults and children. J Bone Joint Surg Am. 1954;36-A:1200-1218.[Abstract]

            • 11. Kamhin M, Engel J, Heim M. The fate of injected trigger fingers. Hand. 1983;15:218-220. [Abstract]

            • 12. Weilby A. Trigger finger: incidence in children and adults and the possibility of a predisposition in certain age groups. Acta Orthop Scand. 1970;41:419-427. [Abstract]

            • 13. Trezies AJ, Lyons AR, Fielding K, et al. Is occupation an aetiological factor in the development of trigger finger? J Hand Surg Br. 1998;23:539-540.[Abstract]

            • 14. Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. J Hand Surg Am. 2002;27:322-324.[Abstract]

            • 15. Wolf JM, Sturdivant RX, Owens BD. Incidence of de Quervain's tenosynovitis in a young, active population. J Hand Surg Am. 2009;34:112-115.[Abstract]

            • 16. Sampson SP, Badalamente MA, Hurst LC, et al. Pathobiology of the human A1 pulley in trigger finger. J Hand Surg Am. 1991 Jul;16(4):714-21.[Abstract]

            • 17. Keon-Cohen B. De Quervain's disease. J Bone Joint Surg Br. 1951 Feb;33-B(1):96-9.[Abstract][Full Text]

            • 18. Piver JD, Raney RB. De Quervain's tendovaginitis. Am J Surg. 1952 Mar;83(5):691-4.[Abstract]

            • 19. Bunnell S. Injuries of the hand. In: Surgery of the hand. Philadelphia, PA: JB Lippincott; 1944:496-499.

            • 20. Hueston JT, Wilson WF. The aetiology of trigger finger explained on the basis of intratendinous architecture. Hand. 1972;4:257-260. [Abstract]

            • 21. Garti A, Velan GJ, Moshe W, et al. Increased median nerve latency at the carpal tunnel of patients with "trigger finger": comparison of 62 patients and 13 controls. Acta Orthop Scand. 2001;72:279-281. [Abstract]

            • 22. Leao L. De Quervain's disease: a clinical and anatomical study. J Bone Joint Surg Am. 1958;40:1063-1070.[Abstract]

            • 23. Stahl S, Kanter Y, Karnielli E. Outcome of trigger finger treatment in diabetes. J Diabetes Complications. 1997;11:287-290. [Abstract]

            • 24. Koh S, Nakamura S, Hattori T, et al. Trigger digits in diabetes: their incidence and characteristics. J Hand Surg Eur Vol. 2010 May;35(4):302-5.[Abstract]

            • 25. Cassebaum WH. Colles' fracture: a study of end results. JAMA. 1950;143:963-965.[Abstract]

            • 26. Dobyns JH. Complications of treatment of fractures and dislocations of the wrist. In: Epps CH Jr, ed. Complications in orthopaedic surgery. Philadelphia, PA: JB Lippincott; 1978:289-290.

            • 27. Engkvist O, Lundborg G. Rupture of the extensor pollicis longus tendon after fracture of the lower end of the radius: a clinical and microangiographic study. Hand. 1979;11:76-86.[Abstract]

            • 28. Lanzetta M, Howard M, Conolly WB. Post-traumatic triggering of extensor pollicis longus at the dorsal radial tubercle. J Hand Surg Br. 1995;20:398-401.[Abstract]

            • 29. Fitton J, Shea FW, Goldie W. Lesions of the flexor carpi radialis tendon and sheath causing pain at the wrist. J. Bone Joint Surg Br. 1968;50:359-363.[Abstract][Full Text]

            • 30. Chen PT, Zhang HW, Tsai ZR, et al. Association between hyperlipidemia and trigger finger: a nationwide population-based cohort study. PLoS One. 2023;18(7):e0288426.[Abstract][Full Text]

            • 31. American College of Radiology. ACR-SABI-SPR-SSR practice parameter for the performance of magnetic resonance imaging (MRI) of the wrist. Aug 2023 [internet publication].[Full Text]

            • 32. American College of Radiology. ACR-SPR-SSR practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the fingers and toes. 2023 [internet publication].[Full Text]

            • 33. Blood TD, Morrell NT, Weiss AP. Tenosynovitis of the hand and wrist: a critical analysis review. JBJS Rev. 2016 Mar 29;4(3):01874474-201603000-00001.[Abstract]

            • 34. Grundberg AB, Reagan DS. Pathologic anatomy of the fore-arm: intersection syndrome. J Hand Surg Am. 1985;10:299-302.[Abstract]

            • 35. Satonaka H, Tsujii M, Sudo A. Tenosynovitis of the extensor pollicis longus tendon caused by an intratendinous ganglion: a case report. J Hand Surg Eur Vol. 2014;39:669-671.[Abstract]

            • 36. Kardashian G, Vara AD, Miller SJ, et al. Stenosing synovitis of the extensor pollicis longus tendon. J Hand Surg Am. 2011;36:1035-1038.[Abstract]

            • 37. Bajaj S, Pattamapaspong N, Middleton W, et al. Ultrasound of the hand and wrist. J Hand Surg Am. 2009;34:759-760.[Abstract]

            • 38. Jacob D, Cohen M, Bianchi S. Ultrasound imaging of non-traumatic lesions of wrist and hand tendons. Eur Radiol. 2007;17:2237-2247.[Abstract]

            • 39. Wong DC, Wansaicheong GK, Tsou IY. Ultrasonography of the hand and wrist. Singapore Med J. 2009;50:219-225.[Abstract][Full Text]

            • 40. Futami T, Itoman M. Extensor carpi ulnaris syndrome: findings in 43 patients. Acta Orthop Scand. 1995;66:538-539. [Abstract]

            • 41. Garsten P. Stenosis of the extensor carpi ulnaris tendon sheath. Acta Chir Scand. 1951;101:85-90. [Abstract]

            • 42. American College of Radiology. ACR-SPR-SSR practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of bone, joint, and soft tissue infections in the extremities. 2021 [internet publication].[Full Text]

            • 43. Freiberg A, Mulholland RS, Levine R. Nonoperative treatment of trigger fingers and thumbs. J Hand Surg Am. 1989;14:553-558.[Abstract]

            • 44. Griggs SM, Weiss AP, Lane LB, et al. Treatment of trigger finger in patients with diabetes mellitus. J Hand Surg Am. 1995;20:787-789.[Abstract]

            • 45. Kolind-Sorensen V. Treatment of trigger fingers. Acta Orthop Scand. 1970;41:428-432. [Abstract]

            • 46. Lapidus PW, Guidotti FP. Stenosing tenovaginitis of the wrist and fingers. Clin Orthop Relat Res. 1972;83:87-90. [Abstract]

            • 47. Marks MR, Gunther SF. Efficacy of cortisone injection in treatment of trigger fingers and thumbs. J Hand Surg Am. 1989;14:722-727.[Abstract]

            • 48. Peters-Veluthamaningal C, van der Windt DA, Winters JC, et al. Corticosteroid injection for trigger finger in adults. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005617.[Abstract][Full Text]

            • 49. Pace CS, Blanchet NP, Isaacs JE. Soft tissue atrophy related to corticosteroid injection: review of the literature and implications for hand surgeons. J Hand Surg Am. 2018 Jun;43(6):558-63.[Abstract][Full Text]

            • 50. Tunçez M, Turan K, Aydın ÖD, et al. Ultrasound guided versus blinded injection in trigger finger treatment: a prospective controlled study. J Orthop Surg Res. 2023 Jun 26;18(1):459.[Abstract][Full Text]

            • 51. Leow MQH, Zheng Q, Shi L, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for trigger finger. Cochrane Database Syst Rev. 2021 Apr 14;4(4):CD012789.[Abstract][Full Text]

            • 52. Liu DH, Tsai MW, Lin SH, et al. Ultrasound-guided hyaluronic acid injections for trigger finger: a double-blinded, randomized controlled trial. Arch Phys Med Rehabil. 2015;96:2120-2127.[Abstract][Full Text]

            • 53. Kanchanathepsak T, Pichyangkul P, Suppaphol S, et al. Efficacy comparison of hyaluronic acid and corticosteroid injection in treatment of trigger digits: a randomized controlled trial. J Hand Surg Asian Pac Vol. 2020 Mar;25(1):76-81.[Abstract]

            • 54. Khan M, Shanmugaraj A, Prada C, et al. The role of hyaluronic acid for soft tissue indications: a systematic review and meta-analysis. Sports Health. 2023 Jan-Feb;15(1):86-96.[Abstract][Full Text]

            • 55. Bain GI, Wallwork NA. Percutaneous A1 pulley release: a clinical study. Hand Surg. 1999;4:45-50. [Abstract]

            • 56. Cihantimur B, Akin S, Ozcan M. Percutaneous treatment of trigger finger: 34 fingers followed 0.5-2 years. Acta Orthop Scand. 1998;69:167-168. [Abstract]

            • 57. Eastwood DM, Gupta KJ, Johnson DP. Percutaneous release of the trigger finger: an office procedure. J Hand Surg Am. 1992;17:114-117.[Abstract]

            • 58. Ha KI, Park MJ, Ha CW. Percutaneous release of trigger digits. J Bone Joint Surg Br. 2001;83:75-77.[Abstract][Full Text]

            • 59. Lyu SR. Closed division of the flexor tendon sheath for trigger finger. J Bone Joint Surg Br. 1992;74:418-420.[Abstract][Full Text]

            • 60. Pope DF, Wolfe SW. Safety and efficacy of percutaneous trigger finger release. J Hand Surg Am. 1995;20:280-283.[Abstract]

            • 61. Stothard J, Kumar A. A safe percutaneous procedure for trigger finger release. J R Coll Surg Edinb. 1994;39:116-117. [Abstract]

            • 62. Tanaka J, Muraji M, Negoro H, et al. Subcutaneous release of trigger thumb and fingers in 210 fingers. J Hand Surg Br. 1990;15:463-465.[Abstract]

            • 63. Lapègue F, André A, Meyrignac O, et al. US-guided percutaneous release of the trigger finger by using a 21-gauge needle: a prospective study of 60 cases. Radiology. 2016 Feb 25 [Epub ahead of print].[Abstract][Full Text]

            • 64. Ilyas AM. Nonsurgical treatment for de Quervain's tenosynovitis. J Hand Surg Am. 2009;34:928-929.[Abstract]

            • 65. Ashraf MO, Devadoss VG. Systematic review and meta-analysis on steroid injection therapy for de Quervain's tenosynovitis in adults. Eur J Orthop Surg Traumatol. 2014;24:149-157.[Abstract]

            • 66. Mardani-Kivi M, Karimi Mobarakeh M, Bahrami F, et al. Corticosteroid injection with or without thumb spica cast for de Quervain tenosynovitis. J Hand Surg Am. 2014;39:37-41.[Abstract]

            • 67. Cavaleri R, Schabrun SM, Te M, et al. Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: a systematic review and meta-analysis. J Hand Ther. 2016;29:3-11.[Abstract][Full Text]

            • 68. Arons MS. de Quervain's release in working women: a report of failures, complications, and associated diagnoses. J Hand Surg Am. 1987;12:540-544.[Abstract]

            • 69. Belsole RJ. De Quervain's tenosynovitis: diagnostic and operative complications. Orthopedics. 1981;4:899-903.

            • 70. Louis DS. Incomplete release of the first dorsal compartment: a diagnostic test. J Hand Surg Am. 1987;12:87-88.[Abstract]

            • 71. Kang HJ, Koh IH, Jang JW, et al. Endoscopic versus open release in patients with de Quervain's tenosynovitis: a randomised trial. Bone Joint J. 2013;95-B:947-951.[Abstract]

            • 72. Schumacher HR Jr, Dorwart BB, Korzeniowski OM. Occurrence of De Quervain's tendinitis during pregnancy. Arch Intern Med. 1985;145:2083-2084.[Abstract]

            • 73. Schned ES. De Quervain tenosynovitis in pregnant and postpartum women. Obstet Gynecol. 1986;68:411-414. [Abstract]

            • 74. Hajj AA, Wood MB. Stenosing tenosynovitis of the extensor carpi ulnaris. J Hand Surg Am. 1986;11:519-520.[Abstract]

            • 75. Kip PC, Peimer CA. Release of the sixth dorsal compartment. J Hand Surg Am. 1994;19:599-601.[Abstract]

            • 76. Nachinolcar UG, Khanolkar KB. Stenosing tenovaginitis of extensor carpi ulnaris: brief report. J Bone Joint Surg Br. 1988;70:842.[Abstract][Full Text]

            • 77. Rodgers WB, Waters PM. Incidence of trigger digits in newborns. J Hand Surg Am. 1994:19:364-368.[Abstract]

            • 78. Fiorini HJ, Tamaoki MJ, Lenza M, et al. Surgery for trigger finger. Cochrane Database Syst Rev. 2018 Feb 20;2:CD009860.[Abstract][Full Text]

            • 79. Luther GA, Murthy P, Blazar PE. Cost of immediate surgery versus non-operative treatment for trigger finger in diabetic patients. J Hand Surg Am. 2016 Nov;41(11):1056-63.[Abstract]

            • 80. Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J Hand Surg Am. 1994;19:595-598.[Abstract]

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