Portal de Periódicos da CAPES

Tethered Thumb Sign: A Unique Observation in the Physical Examination of de Quervain Tenosynovitis

2013; Elsevier BV; Volume: 38; Issue: 6 Linguagem: Inglês

10.1016/j.jhsa.2013.04.017

1531-6564

Erica Taylor, Avrum I. Froimson,

Rabies epidemiology and control

Stenosing tenosynovitis of the first dorsal compartment of the wrist is a painful condition that we see frequently. Because radial-sided wrist pain can be attributed to pathologies outside the first compartment, the clinician should ensure that an accurate assessment of the upper extremity is performed to confirm the diagnosis and guide appropriate treatment. A key examination tool is the maneuver characterized by Eichoff and Finklestein,1Ahuja N.K. Chung K.C. Fritz de Quervain, MD (1868–1940): Stenosing tendovaginitis at the radial styloid process.J Hand Surg Am. 2004; 29: 1164-1170Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar in which the patient clenches the thumb in the palm while the wrist is moved into ulnar deviation. This test can be quite painful at times. Thus, we advise first using an adjunctive tool developed by the senior author (A.I.F.). This proposed maneuver elicits a characteristic response in many of the patients who have de Quervain tenosynovitis.The patient places his or her hands onto the table in a resting position. The clinician then grasps the fingers and brings both wrists into gentle ulnar deviation, allowing the thumb to remain free. In absence of pathology, the thumb follows the cascade of the rest of the hand into ulnar deviation. However, if there is stenosis of the first dorsal compartment, the thumb is tethered and remains aligned with the forearm while the rest of the hand falls into ulnar deviation (Fig. 1).We liken the finding of a tethered thumb to an accentuated tenodesis effect of the extensor pollicis brevis and abductor pollicis longus tendons, leading to the fixed position of the thumb with passive wrist ulnar deviation. We believe that this clinical maneuver can support the diagnosis of de Quervain tenosynovitis and assist in determining an effective treatment algorithm. Stenosing tenosynovitis of the first dorsal compartment of the wrist is a painful condition that we see frequently. Because radial-sided wrist pain can be attributed to pathologies outside the first compartment, the clinician should ensure that an accurate assessment of the upper extremity is performed to confirm the diagnosis and guide appropriate treatment. A key examination tool is the maneuver characterized by Eichoff and Finklestein,1Ahuja N.K. Chung K.C. Fritz de Quervain, MD (1868–1940): Stenosing tendovaginitis at the radial styloid process.J Hand Surg Am. 2004; 29: 1164-1170Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar in which the patient clenches the thumb in the palm while the wrist is moved into ulnar deviation. This test can be quite painful at times. Thus, we advise first using an adjunctive tool developed by the senior author (A.I.F.). This proposed maneuver elicits a characteristic response in many of the patients who have de Quervain tenosynovitis. The patient places his or her hands onto the table in a resting position. The clinician then grasps the fingers and brings both wrists into gentle ulnar deviation, allowing the thumb to remain free. In absence of pathology, the thumb follows the cascade of the rest of the hand into ulnar deviation. However, if there is stenosis of the first dorsal compartment, the thumb is tethered and remains aligned with the forearm while the rest of the hand falls into ulnar deviation (Fig. 1). We liken the finding of a tethered thumb to an accentuated tenodesis effect of the extensor pollicis brevis and abductor pollicis longus tendons, leading to the fixed position of the thumb with passive wrist ulnar deviation. We believe that this clinical maneuver can support the diagnosis of de Quervain tenosynovitis and assist in determining an effective treatment algorithm.