De Quervain's tenosynovitis

• Pain radiating from the thumb to the first extensor compartment on radial side of the wrist.
• Pain is aggravate by lifting the thumb, as in the hitchhiker position or a combination of grip and twist activities.
• Tenderness on palpation
• Swelling over radial compartment of extensor retinaculum – compare it with same spot on the opposite wrist.
• Crepitus on movement
• Positive Finklesteins test

• Immobilise in wrist thumb splint for 2 weeks
• Ice every couple of hours
• Anti-inflammatory medication
• Activity modification – avoid repetitive grip/twist activities, allow for periods of rest, reduce all aggravating factors, reduce grip strain e.g. padded grips on utensils , pens , knives etc

• Follow conservative management advice and provide patient with attached information. DE QUERVAIN'S PATIENT LETTER* (this includes advice re purchasing the appropriate splints).
• If initial conservative advice fails to settle symptoms consider steroid injection by appropriately trained Healthcare practitioner (less successful in Diabetic Patients).
• If symptoms persist local injections can be repeated - Maximum of 2 injections in total 6 weeks apart. If symptoms persist despite two injections surgical release might be required.
• If this skill is not available in surgery refer into OT Hand clinic.

• If symptoms persist following 6-8 weeks of self management

Refer via SCI Gateway to Occupational Therapy Hand Clinic and include following in referral:

• Occupation
• Duration of; Symptoms, Self management
• Precipitating factors i.e. injury/trauma, occupation
• Provocative testing (Finkelsteins)