Description
- In patients with dorsal tenosynovitis, the tenosynovium becomes hypertrophic and causes pain as the extensor tendons move on the dorsum of the hand and wrist.
- Persistent proliferative dorsal tenosynovitis can cause extensor tendon rupture.1
- If the tenosynovitis affects only the first dorsal compartment, which includes the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB), it is called de Quervain’s disease. Symptoms of de Quervain’s include swelling at the radial styloid. However, de Quervain’s often occurs with hypertrophic tenosynovial changes.2
Pathophysiology
- Dorsal tenosynovitis may arise from rheumatoid arthritis (RA), osteoarthritis or tuberculosis. Patients presenting with RA often have involvement of the radiocarpal and distal radioulnar joints and the overlying extensor tendons.1
Instructions
- Palpate along the extensor tendons in the affected wrist to check for tenderness, nodules, crepitus and visible dorsal swelling caused by the hypertrophic tenosynovium3
- Check for associated intra-articular synovitis of the radiocarpal or radioulnar joints
Variations
- It is important to evaluate the patient’s contralateral wrist as a comparison, because this test may be painful even in a healthy wrist.1
Diagnostic Performance Characteristics
- If dorsal tenosynovitis cannot be diagnosed by physical tests alone, then tendinopathy may be seen on ultrasound or MRI with fluid-sensitive sequences in the axial plane.
- Tenosynovitis will represent itself as fluid in the sheath.3
