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Osteoarthritis of the Hand/Thumb
Mallet Finger
Ganglion
Dupuytren’s Contracture
De Quervain’s Tenosynovitis
Carpal Tunnel Syndrome
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De Quervain’s Tenosynovitis
Last updated 22nd May 2023
Signs/Symptoms
- 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
Advice in Primary Care
- 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
Actions in Primary Care
- Follow conservative management advice and provide patient with information leaflet
- 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 once more only. If this skill is not available in surgery refer into OT Hand clinic
Referral to Secondary Care
- If symptoms persist following 6-8 weeks of self management REFER VIA SCI GATEWAY TO OCCUPATIONAL THERAPY HAND CLINIC and INCLUDE FOLLWING IN REFERRAL:
- Occupation
- Duration of; Symptoms, Self management
- Precipitating factors i.e. injury/trauma, occupation
- Provocative testing (Finkelsteins)
Links
De Quervain’s Tenosynovitis Information Leaflet
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