Upper Extremity Tenosynovitis and Tendinopathy

https://plasticsinpractice.com/ Radial wrist pain, a locking digit, and lateral elbow pain can all be called overuse—but a few centimeters can change the diagnosis, treatment, and surgical target. In this episode of Plastics in Practice, we map de Quervain tenosynovitis, intersection syndrome, trigger finger, and lateral elbow tendinopathy from focused examination through splinting, injection, rehabilitation, and surgical release. Key takeaways: • Map radial-sided symptoms by location: de Quervain disease localizes at the radial styloid, while intersection syndrome produces dorsoradial pain and often crepitus four to six centimeters proximal to Lister tubercle. • De Quervain disease involves the APL and EPB in the first dorsal compartment; a separate EPB subcompartment can explain incomplete response after injection or release. • Current evidence supports considering corticosteroid injection plus three to four weeks of thumb-spica immobilization as first-line management for de Quervain disease; ultrasonography can help target anatomic subcompartments.[1,2] • Trigger finger localizes to the A1 pulley near the volar metacarpal head—even when the patient feels the click at the PIP joint. • Corticosteroid injection succeeds in roughly two thirds of trigger digits in pooled randomized trials; persistent locking, fixed contracture, or failed conservative care should prompt evaluation for A1 pulley release.[3] • Lateral epicondylitis is better framed as lateral elbow tendinopathy: confirm focal pain with grip or resisted wrist extension, consider radial tunnel symptoms, and avoid promising a rapid cure from any single intervention.[4] This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ #Tenosynovitis #TriggerFinger #DeQuervain #HandSurgery #PlasticSurgeryEducation #PlasticsInPractice References: 1. Challoumas D, Ramasubbu R, Rooney E, et al. Management of de Quervain tenosynovitis: a systematic review and network meta-analysis. JAMA Netw Open. 2023;6(10):e2337001. doi:10.1001/jamanetworkopen.2023.37001 2. He KS, He KS, Cheah A, et al. Unblinding de Quervain: a systematic review of ultrasound-guided injection of corticosteroids for treatment of stenosing tenosynovitis of the first extensor compartment. J Med Radiat Sci. 2023;70(3):319-326. doi:10.1002/jmrs.681 3. Pathak SK, Salunke AA, Menon PH, et al. Corticosteroid injection for the treatment of trigger finger: a meta-analysis of randomised control trials. J Hand Surg Asian Pac Vol. 2022;27(1):89-97. doi:10.1142/S242483552250014X 4. Lowdon H, Chong HH, Dhingra M, et al. Comparison of interventions for lateral elbow tendinopathy: a systematic review and network meta-analysis for Patient-Rated Tennis Elbow Evaluation pain outcome. J Hand Surg Am. 2024;49(7):639-648. doi:10.1016/j.jhsa.2024.03.007