65-year-old male presents with six months of progressively worsening dorsal radial wrist pain. Pain is described as a sharp, shooting pain with certain movements. Exacerbating factors include radial deviation and wrist flexion. Of note, patient is a fly fisher and performs daily manual labor with his hands.
Among the most common causes of tendinopathies of the thumb and wrist are de Quervain’s tenosynovitis (DQT) and intersection syndrome (IS). DQT, also known as “New Moms’ Syndrome”, is seen often in young, female patients who are picking up children daily – a motion that involves repetitive radial deviation of the wrists.
DQT is an inflammation within the first dorsal extensor compartment. IS, in comparison, is due to friction and inflammation where the first dorsal extensor compartment intersects the second dorsal extensor compartment. Repetitive cradling motion, activities such as fly fishing, or manual labor are known causes of IS.
Differentiating between DQT and IS can be challenging in the clinical setting. On physical exam, pain along the radial most aspect of the wrist and a positive Finkelstein’s maneuver favors the diagnosis of DQT. Pain that is more proximal and dorsal in nature or a reported “squeaking” sensation in the wrist with motion is indicative of IS. Aside from tendinopathies, it is also important to rule out first CMC joint arthritis and or scaphoid pathology. Ultrasound or other imaging modalities may be helpful to localize site of tendinopathy.
Initial treatment options for either condition include rest, ice or heat, anti-inflammatories, cortisone injections, or immobilization via bracing. In some cases, surgery may be necessary if conservative measures fail to improve pain. Patient in this case was found to have IS and elected to undergo ultrasound-guided cortisone injection and immobilization with thumb SPICA splint.
References Thomas M. Skinner. The Journal of the American Board of Family Medicine July 2017, 30 (4) 547-551