The Radial Synergy Test: An Aid to Diagnose de Quervain’s Tenosynovitis

Background: Diagnosis of de Quervain’s tenosynovitis is made clinically. Finkelstein’s and Eichoff’s tests are commonly utilized examination maneuvers. Their specificity has been questioned due to a propensity to provoke pain in asymptomatic patients. Using the principle of synergism, the novel radial synergy test takes advantage of isometric contraction of the first dorsal compartment with resisted abduction of the small finger. Methods: Electromyography was performed on 3 authors and the first dorsal compartment sampled during the maneuver. Sensitivity evaluation was performed via retrospective chart review for patients diagnosed with de Quervain’s from 2013 to 2018. Inclusion criteria were documented radial synergy test, Eichoff’s test, and ≥90% pain relief after lidocaine/corticosteroid injection. We enrolled 222 patients with 254 affected extremities. Specificity evaluation was performed via a prospective cohort of volunteers undergoing radial synergy and Eichoff’s tests. Inclusion criterion was lack of preexisting wrist pain. Score > 0 on Visual Analog Scale was considered positive. We enrolled 48 volunteers with 93 tested extremities. Results: Electromyography revealed positive recruitment of the first dorsal compartment. Sensitivity of the radial synergy test was inferior to Eichoff’s test (97% vs 91%, relative risk [RR] = 0.93 [95% confidence interval [CI] = 0.89-0.97], P < .01). Specificity of the radial synergy test was superior to Eichoff’s test (99% vs 74%, RR = 1.33 [95% CI = 1.18-1.51], P < .001). Conclusions: We describe and evaluate the radial synergy test, a novel examination maneuver to aid the diagnosis of de Quervain’s. This serves as an adjunct for future diagnostic evaluations with its high specificity. Level of Evidence: Level II, diagnostic study.

Outcome of Corticosteroid Injection in De Quervain's Tenosynovitis

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material & Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.

Impact of Corticosteroid Injection on The de Quervain’s Tenosynovitis

Background: de Quervain’s tenosynovitis may be caused by thickened extensor retinaculum which holds the tendon in position in wrist. There are both operative and non-operative treatments for the condition. Corticosteroid injection is a very good conservative treatment option. Objective: To see the outcome of corticosteroid Injection in the de Quervain’s Tenosynovitis. Materials and Methods: This was prospective interventional study conducted at the outpatient department of Kurmitola General Hospital during the period from January 2018 to December 2019. Total 71 patients with de Quervain’s tenosynovitis were analyzed. Secondary outcomes were measured by Visual Analogue Scale (VAS) and Quick Disabilities of Arm, Shoulder and Hand (DASH) score. Results: Among the 71 affected hands, 11 (16.22%) patients had recurred. Sixty (83.78%) patients had no positive sign or symptom after 6 months of follow-up. Average VAS before injection was 8.27±1.23. Post injection VAS was 0.82±1.49 at 1 month follow-up and 1.46±2.34 at 6 month follow-up which was improved significantly. Pre-injection average Quick DASH score was 77.33±13.59 which was reduced to 18.34±12.37 after 1 month and 22.97±17.28 after 6 months of follow-up. Conclusion: Single injection of triamcinolone with local anesthetic for the treatment of de Quervain’s disease was proved significant conservative treatment option though there were few complications and failed cases. We should pay more attention to long-term follow-up and proper injection technique. KYAMC Journal.2021;12(02): 88-91