-History and Physical, see above.
– Finkelstein’s test is positive
– Grind test is negative
– There is tenderness to palpation over the radial tubercle.
– Conservative treatment: Rest and a thumb spica wrist splint; anti-inflammatory meds, steroid injection.
Sample presentation: Designer with radial wrist pain for several months. No history of trauma. It hurts to hold a coffee cup.
“This patient has de Quervain’s tenosynovitis. Finkelstein’s test has good sensitivity and specificity (SORC) in patients with a negative grind test. A positive grind test would be more consistent with scaphoid fracture. A hand radiograph with secondary thumb spica splinting would be appropriate for a suspected scaphoid fracture, but the insidious onset as opposed to overt trauma makes this diagnosis unlikely in this case. A short arm cast is not indicated in de Quervain’s tenosynovitis but may be appropriate for forearm/wrist fractures.” ABFM
References
Tallia AF, Cardone DA: Diagnosis and therapeutic injection of the wrist and hand region. Am Fam Physician 2003;67(4):745-750.
Shehab R, Mirabelli MH: Evaluation and diagnosis of wrist pain: A case-based approach. Am Fam Physician 2013;87(8):568-573.