Trigger Finger or De Quervain Tenosynovitis after Surgical Treatment for Carpal Tunnel Syndrome / Dedo em gatilho ou tenossinovite de De Quervain após tratamento cirúrgico da síndrome do túnel do carpo

Abstract Objective To evaluate the open surgical treatment for carpal tunnel syndrome as a risk factor for the development of stenosing tenosynovitis that results in trigger finger and De Quervain disease. Materials and Methods A retrospective study analyzing the medical records of patients submitted to open surgical release of carpal tunnel syndrome between 2010 and 2021 in a secondary- and tertiary-level hospital. The following data were collected: pathological history, duration of the follow-up after the surgical treatment for carpal tunnel syndrome, development of trigger finger or De Quervain tenosynovitis, affected fingers, and the interval between the end of surgery and symptom onset. Results We evaluated 802 patients of both genders and with a mean age of 50.1 (±12.6) years. The mean follow-up was of 13 (±16.4) months. The mean time until the development of trigger finger was of 61.4 months, and of 73.7 months for De Quervain disease. The incidence of development of De Quervain disease was of 4.12%, and for trigger finger it was of 10.2%. The most affected digits were the thumb (47.6%), the middle (24.4%), and the ring finger (8.54%). Age was the only factor that showed an association with the risk of developing trigger finger, with an increase of 2% for each increase in age of 1 year. Conclusion The incidence rates for the development of De Quervain disease (4.12%) and trigger finger (10.2%) after the surgical treatment for carpal tunnel syndrome were like those described in the literature. Only age was a factor that influenced the development of trigger finger.

Resumo Objetivo Avaliar o tratamento cirúrgico aberto da síndrome do túnel do carpo como fator de risco para o desenvolvimento das tenossinovites estenosantes formadoras do dedo em gatilho e da doença de De Quervain. Materiais e Métodos Estudo retrospectivo com análise dos prontuários de pacientes submetidos a liberação cirúrgica aberta da síndrome do túnel do carpo entre 2010 e 2021 em hospital de níveis secundário e terciário. Os seguintes dados foram coletados: histórico patológico, tempo de acompanhamento após o tratamento cirúrgico da síndrome do túnel do carpo, desenvolvimento de dedo em gatilho ou tenossinovite de De Quervain, dedos acometidos, e tempo decorrido entre o fim da cirurgia e o aparecimento dos sintomas. Resultados Foram avaliados 802 pacientes de ambos os sexos com média de idade de 50,1 (±12,6) anos. O tempo médio de seguimento foi de 13 (±16,4) meses. O tempo médio de desenvolvimento de dedo em gatilho foi de 61,4 meses, e o da doença de De Quervain, de 73,7 meses. A incidência de desenvolvimento da doença de De Quervain foi de 4,12% e a de dedo em gatilho, de 10,2%. Os dedos mais acometidos foram o polegar (47,6%), o médio (24,4%) e o anular (8,54%). A idade foi único fator que demonstrou associação com o risco de desenvolvimento de dedo em gatilho, com aumento de 2% a cada ano a mais de idade. Conclusão As taxas de incidência de desenvolvimento de doença de De Quervain (4,12%) e de dedo em gatilho (10,2%) após tratamento cirúrgico da síndrome do túnel do carpo foram semelhantes às descritas na literatura. Apenas a idade se apresentou como fator influenciador no desenvolvimento de dedo em gatilho.

Prevalencia de los signos de Finkelstein y Eichhoff en una población sana / Prevalence of Finkelstein's and Eichhoff's Tests in a Healthy Population

RESUMEN Introducción: La enfermedad de De Quervain es frecuente en población laboralmente activa y su diagnóstico puede ser un reto. Las maniobras de Finkelstein y Eichhoff son pruebas semiológicas utilizadas para el diagnóstico de esta patología, cuyo rendimiento diagnóstico real no es claro. El objetivo de este trabajo es determinar la prevalencia de los signos de Finkelstein y Eichhoff en una población de individuos sanos en edad laboral, buscando determinar el valor real de un hallazgo positivo. Materiales y métodos: Es un estudio de corte transversal, descriptivo. La muestra está conformada por individuos sanos entre 18 y 45 años, de sexo masculino y femenino, que participan de forma voluntaria. A todos los participantes se les realizaron ambas maniobras; se llevó registro de las pruebas que resultaron positivas y de los pacientes que refirieron dolor o incomodidad. Resultados: Participaron 65 pacientes y se registraron datos de 129 extremidades. La edad promedio fue 26 años; el número promedio de horas laborales diarias fue 9,3. El signo de Finkelstein tuvo una prevalencia de 33,3 %; el signo de Eichhoff de 75,2 %. La única variable que aumenta el riesgo de presentar una prueba positiva (Eichhoff) de forma estadísticamente significativa es el sexo masculino (OR 2,4, IC 95 % 1,05-5,73). Conclusiones: El signo de Finkelstein es más específico que el de Eichhoff, sin embargo, no es patognomónico de tenosinovitis de De Quervain. La maniobra de Eichhoff no es recomendable para la exploración física de los pacientes, puede ser incómoda y generar confusión.

ABSTRACT Introduction: DeQuervain's disease is common in the working population and its diagnosis may be a challenge. Finkelstein's and Eichhoff's tests are semiological tests used for the diagnosis of this pathology, and their diagnostic performance is not clear. The objective of this work is to determine the prevalence of the tests in a healthy, working-age population, seeking to quantify the real value of a positive finding. Materials and methods: It is a cross-sectional descriptive study. The sample is made up of healthy individuals, between 18 and 45 years of age, male and female, who participate voluntarily. All participants underwent both tests, and a record of the tests that were positive was taken. Also, a register of the patients who reported pain or discomfort was kept. Results: 65 patients participated and data from 129 limbs were recorded. The average age was 26 years. The average number of daily work hours was 9.3. Finkelstein's test had a prevalence of 33.3%; Eichhoff's test of 75.2%. The only variable that was statistically significant for an increase in the risk of presenting a positive test (Eichhoff) was male sex (OR 2.4, 95% CI 1.05-5.73). Conclusions: Finkelstein's test is more specific than Eichhoff's, however, it is not pathognomonic for DeQuervain tenosynovitis. Eichhoff's test is not recommended for the physical examination of patients, it can be uncomfortable and cause confusion

Successful Treatment with Tokishakuyakusan for de Quervain Disease and Carpal Tunnel Syndrome after Delivery / 日本東洋医学雑誌

De Quervain disease and carpal tunnel syndrome are major problems that occur after delivery. During pregnancy, hormone confusion readily causes inflammation of tendons ;furthermore, overuse of hands during care of other children contributes to symptom onset. We report four cases of de Quervain and carpal tunnel syndrome occurred after delivery. All patients were women, aged 33-­39 years. All patients breast-­fed after birth. One patient was diagnosed with de Quervain disease, two were diagnosed with carpal tunnel syndrome, and one was diagnosed with de Quervain disease accompanied by carpal tunnel syndrome. All patients received tokishakuyakusan ;thereafter, their pain decreased, but slight numbness from the carpal tunnel syndrome remained. Drugs that can be used during breastfeeding are limited ;however, tokishakuyakusan can be prescribed safely and effectively.

The Relationship between Physical Findings and the Recurrence after Steroid Injection in De Quervain's Disease

PURPOSE: The purpose of this study was to evaluate the effect of steroid injection according to the stage of Finkelstein's test and the severity of tenderness on radial styloid in de Quervain's disease. METHODS: Between January 2011 and December 2012, a total of 57 patients (57 wrists) treated with steroid injection in de Quervain's disease were enrolled on this study. The severity of tenderness, the stage of Finkelstein's test and pain score using visual analogue scale (VAS) were assessed before steroid injection. And the effect of steroid injection was assessed until one year after steroid injection. The relationship between the recurrence of de Quervain's disease after steroid injection and pre-injection findings including tenderness, Finkelstein's test and VAS was assessed. RESULTS: The success rate of steroid injection was 71.9% (41/57 patients). The outcome of steroid injection was not significantly related to the severity of tenderness (p=0.648), the stage of Finkelstein's test (p=0.530) and VAS score (p=0.607). CONCLUSION: The tenderness on radial styloid and the Finkelstein's test are important physical findings for the diagnosis of de Quervain's disease. However, the severity of tenderness and the stage of Finkelstein's test were not showed as predictive factors for the outcome.

Ibuprofen timing for hand surgery in ambulatory care

OBJECTIVE: To evaluate the effect of pre-operative administration of ibuprofen on post-operative pain control vs. early post-operative administration for hand surgery procedures performed under local anaesthesia in ambulatory care. METHODS: Candidates to trigger finger release by De Quervain tenosynovitis and carpal tunnel operation under local anesthesia were enrolled in the study. Group A received 400 mg ibuprofen before the operation and placebo after the procedure; group B received placebo before the operation and ibuprofen 400 mg at the end of the procedure; both groups received ibuprofen 400 mg every 6h thereafter. Visual analogue scale (VAS) was measured at fixed times before and every 6h after surgery, for a total follow-up of 18h. RESULTS: Groups were similar according to age, gender and type of surgery. Median VAS values did not produce any statistical significance, while there was a statistically significant difference on pre-operative and early post-operative VAS values between groups (A -8.53 mm vs. B 3.36 mm, p=0.0085). CONCLUSION: Average pain levels were well controlled by local anesthesia and post-operative ibuprofen analgesia. Pre-operative ibuprofen administration can contribute to improve early pain management. Level of Evidence II, Therapeutic Studies.

Tenosinovitis estenosante digital en pacientes de un Hospital Universitario / Digital stenosing tenosynovitis in patients of a University Hospital

La tenosinovitis es el engrosamiento del recubrimiento alrededor de los tendones de los dedos que resulta en una condición estenosante o dedo en resorte/gatillo (DR).Objetivo: Analizar la tenosinovitis estenosante en los pacientes que acudieron a la consulta de reumatología del hospital "Dr. Adolfo Prince Lara". Materiales y Métodos: Investigación cuantitativa, correlacional, transversal. Población integrada por 285 pacientes, muestra 105 pacientes con diagnóstico clínico de tenosinovitis estenosante. Resultados: Edad promedio de 55,32 años. Siendo 80% del sexo femenino. Ocupación predominante oficios del hogar 71,43%. Patologías médicas asociadas: Diabetes Mellitus 61,19%, Hipertensión Arterial 49,225% y Reumatológi cas: Osteoartrosis 48,49%, Tendinitis de D´Quervain 46,77%. Localización anatómica más frecuente el dedo anular (45,71%) seguida por el dedo pulgar (23,81%; 25 casos). Diagnóstico clínico en el 100% de los casos. Tratamiento más utilizado Aines con infiltración 75,24% remisión en 80% de los pacientes. Conclusión: La tenosinovitis estenosante representa más de un terc io de los pacientes que acuden a la consulta de reumatología, afecta principalmente a los adultos contemporáneos, de sexo femenino, diabéticos, de ocupación oficios del hogar u obreros, siendo el digito más afectado el anular, con 80% de remisión posterior a infiltración local y AINES administrado por via oral.

Tenosynovitis is the thickening of the lining around the tendons of fingers resulting in a condition stricturing, or spring/ trigger (ST) finger. Objective: Analyze the tenosynovitis in patients who come to the Rheumatology consult of the "Dr. Adolfo Prince Lara" hospital. Materials and methods: Quantitative, correlational and cross-sectional research. Population composed of 285 patients, sample of 105 patients with clinical diagnosis of tenosynovitis. Results: Average age of 5 5.32. 80% were female. Predominant occupation was home offices with 71.43%. Medical conditions associated: Diabetes Mellitus 61.19%, hypertension 49.22% and rheumatologic: 48.49% osteoarthritis, D´Quervain Tendinitis 46.77%. Anatomic location more frequent the ring finger (45.71%) followed by the thumb finger (23.81%; 25 cases). Clinical diagnosis in 100% of cases . Treatment most used nonsteroidal anti-inflammatory drugs (NSAIDs) with infiltration 75.24%, remission in 80% of patients. Conclusion: Tenosynovitis represents more than one third of the patients who come to the rehumatology consultation, mainly affects adult contemporary, female sex, diabetic, occupation offices of home or workers, being the ring finger the most affected, with 80% of remission after local infiltration and NSAIDs.

Lesiones osteomusculares en tejedores de máquinas circulares de una empresa textil del municipio de Cota,Cundinamarca Colombia, 2012 / Musculoskeletal injuries in workers handling circular weaving machines, at a textile company located in a municipality of Cundinamarca, Colombia 2012

Describir algunos factores sociodemográficos y ocupacionales en un grupo de trabajadores tejedores del área de circulares, quienes operan máquinas marca Monarch en una Empresa Textil en Bogotá entre los meses de Octubre 2011 a Junio de 2012. Materiales y Métodos: Estudio descriptivo, Serie de Casos. La población en estudio fueron trabajadores tejedores mayores de 18 años que presentan lesiones osteomusculares, y que operan máquinas MONARCH en el Área de Circulares de una Empresa Textil en Bogotá. De 300 trabajadores, 150 presentaron síntomas, de ellos 94 cumplieron con los criterios de inclusión. Resultados: Se encontró que el 68,1% de lapoblación estudiada presentó dolor lumbar, Hombro doloroso 28,7%, Epicondilitis es del 18,1% y Síndrome de Túnel del carpo en el 17%. Se presentaron en el 72% una lesión osteomuscular y en un 22% dos lesiones. La combinación más frecuente fue dolor lumbar y hombro doloroso en 38,1%. El dolor lumbar fue más frecuente entre los31 y 45 años (72,7%). Conclusiones: La lesión osteomuscular más frecuente fue el dolor lumbar, cuando se presentó como única lesión o en combinación con otras. Los trabajadores presentaron con mayor frecuencia una sola lesión osteomuscular, siendo menos frecuente las asociaciones entre estas. Los trabajadores realizaban actividad física en un 40,9% debido a que la bicicleta es su medio de transporte diario. Sería importante en próximos estudios comparar población asintomática con la población con alguna patología osteomuscular para hacer asociaciones y establecer posibles factores protectores y de riesgo...

Surgical Release of the First Extensor Compartment for Refractory de Quervain's Tenosynovitis: Surgical Findings and Functional Evaluation Using DASH Scores

BACKGROUND: Few studies have evaluated surgical outcomes in patients with refractory de Quervain's disease using validated outcome measures. We assessed the clinical outcomes of dorsal release of the first extensor compartment for the treatment of de Quervain's disease using the disabilities of the arm, shoulder and hand (DASH) score. METHODS: From October 2003 to May 2009, we retrospectively evaluated 33 patients (3 men and 30 women) who underwent surgical treatment for de Quervain's disease. All patients had a positive Finkelstein test and localized tenderness over the first dorsal compartment. All operations were performed under local anesthesia. A 2-cm-long transverse skin incision was made over the first extensor compartment and the dorsal retinaculum covering the extensor pollicis brevis was incised longitudinally. Preoperative and postoperative clinical evaluation included the use of DASH score, Finkelstein test, and visual analogue scale (VAS) score. RESULTS: In 18 patients (55%), the extensor pollicis brevis tendon compartment was separated from the abductor pollicis longus compartment. Eight patients had intracompartmental ganglia in the extensor pollicis brevis subcompartment. All patients except one had negative sign on Finkelstein test at the last follow-up. The average VAS score decreased from 7.42 preoperatively to 1.33 postoperatively (p < 0.05), and DASH score was improved from 53.2 to 3.45 (p < 0.05). There were no postoperative complications such as subluxation of the tendon of the first dorsal compartment or injury to the sensory branch of the radial nerve. CONCLUSIONS: Intracompartment ganglia and the separate septum of extensor pollicis brevis are often related to de Quervain's disease. The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity.

Tenossinovites De Quervain: uma nova proposta no tratamento cirúrgico / De Quervain’s tenosynovitis: a new proposal of surgical treatment

Introdução: A tenossinovite estenosante De Quervain caracteriza-se por ser a inflamação da bainha do abdutor longo e extensor curto do polegar, no primeiro compartimento dorsal do punho, acometendo mais frequentemente as mulheres na faixa etária entre 30 e 50 anos. Essa doença está associada principalmente a trauma crônico secundário e sobrecarga das atividades diárias das mãos e punho, podendo também ser causada por outros fatores, mas em muitos casos não há uma causa bem definida. Objetivo: O objetivo deste trabalho é apresentar nossa casuística de tenossinovite de De Quervain no Ambulatório de Cirurgia da Mão, os diferentes tratamentos e uma nova proposta cirúrgica utilizando um retalho fáscio-gorduroso de vizinhança. Resultados: Com a técnica proposta foram obtidos resultados satisfatórios, diminuindo as recidivas, com boa recuperação funcional e rápido retorno dos pacientes às atividades cotidianas.

Introduction: De Quervain’s stenosing tenosynovitis it is characterized by being the inflammation of the hem of the long and extending abductor short of the thumb, in the 1st number compartment of the fist, more frequently attacking the women in the age group between 30 and 50 years. That pathology is associated mainly to secondary chronic trauma and overload of the daily activities of the hands and fist, could also be caused by other factors, but in many cases no there is a very defined cause. Results: All the patients had a faster and satisfactory evolution with an amazing come back to their quotidian activities.

Septated de Quervain's Disease with MRI Images: A case report

De Quervain's disease is the most common form of tenosynovitis, which causes disability in daily living and occupational activity. Anatomical variations in the first extensor compartment including separate comparment influenced the effects of treatment. A 45-year-old woman had severe pain on wrist and suffered in activity of daily living after motor vehicle accident. She had swelling and tenderness upon the radial styloid process, and more aggravated pain by Finkelstein's maneuver test. The magnetic resonance imaging (MRI) scans showed severe peritendinous edema within the synovial sheath, increased signal intensity within the tendons. Also, the images revealed a thickened septum between abductor pollicis longus and extensor pollicis brevis. Corticosteroid was injected on both sides of the septum. We report a case of definite septum of de Quervain's disease via MRI scans.

De Quervain's Disease Associated with Osseous Septum: A Case Report / 대한정형외과학회잡지

A septum between the abductor pollicis longus tendon and the extensor pollicis brevis tendon in the first extensor compartment is frequently encountered during the surgical treatment of de Quervain's disease. But de Quervain's disease associated with a bone tumor and an osseous septum is very rare. We treated a patient with de Quervain's disease who had a bone tumor and an osseous septum between the abductor pollicis longus tendon and the extensor pollicis brevis tendon in the first extensor compartment. After the excision, the pain was relieved and Finkelstein's test was negtive. We report upon this case, and includea brief review of the literature.

Anatomical variations of the first extensor compartment affecting surgery in de Quervain’s disease.

151 wrists of Thai cadavers were dissected to determine the anatomical variations of tendons of the abductor pollicis longus and extensor pollicis brevis muscles as they lie in the first extensor compartment of the wrists. Such variation involves division of the abductor pollicis longus tendon and the extensor pollicis brevis tendon. Additionally, the main compartment is usually divided into two sub-compartments by a fibrous septum, one for the abductor pollicis longus and its accessory tendons (one to five tendons), the other for the extensor pollicis brevis and one accessory tendon. Septation varied involving the distal one-third to the entire compartment. The abductor pollicis longus has only tendon that inserts into the base of the first metacarpal; the accessory tendon inserts upon the dorsal surface of the base of the distal phalanx of the thumb. Therefore, in the surgical decompression for de Quervain’s disease, the recognition of the presence of these tendons and in particular the presence or absence of a separate osteo-fibrous compartment is of great importance. In addition knowledge of the location of their insertions should be useful for transfer procedures.