Which of the following describes the pathology of De Quervain's tenosynovitis?
A. Irritation of a tendon located on the radial side of the wrist, near the thumb.
B. Impingement of the median nerve, causing pain in the palm and fingers
C. Fluid-filled cyst that typically develops adjacent to a tendon sheath in the wrist
D. Ulnar nerve compression at the olecranon process
ANS: A
De Quervain's tenosynovitis involves irritation of a tendon located on the radial side of the wrist, near the thumb. With overuse, the tissues surrounding the tendon sheath hypertrophy, causing pressure on the tendon and making it difficult to move. The pain is usually limited to the radial aspect of the wrist and area immediately around the base of the thumb. Pain increases with use of the hand, such as with gripping maneuvers. Other symptoms include swelling, decreased sensation, and limited ROM with a locking sensation with thumb motion. The Finkelstein maneuver (Fig. 14.7) is used to diagnose De Quervain's disease. A positive test results in pain, which is often severe. Patients who can repeatedly open and close the fist with smooth thumb motion are unlikely to have De Quervain's.
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