580 - A Pain to Play with her Grandson: Bilateral De Quervain Tenosynovitis

Case Diagnosis: Bilateral De Quervain Tenosynovitis

Case Description: 50-year-old female presented for evaluation of bilateral wrist pain that started insidiously three months prior to presentation. The pain would start in the wrist and extend to her first four digits bilaterally, limiting the patient’s ability to perform ADLs and control her Rollator. The pain made It difficult to lift her grandson. Physical exam was remarkable for tenderness to palpation of the first four metacarpals bilaterally with right wrist and finger strength limited by pain. Finkelstein Test was positive bilaterally.

The patient was treated with injection of first dorsal extensor compartments bilaterally. She had significant pain relief with wrist movement, metacarpal palpation, and repeat Finkelstein Test was negative bilaterally post-injection.

Discussions: De Quervain Tenosynovitis involves irritation of the tendons of the first dorsal compartment of the wrist and is associated with repetitive movements of the wrist. Bilateral involvement is more common in those frequently lifting young children. Corticosteroid injections tend to offer significant relief to patients, particularly ultrasound-guided injections, which can be equally efficacious to surgery. Ultrasound-guided corticosteroid injections may be particularly efficacious due to some patients having an intercompartmental septum in the first dorsal extensor compartment. Corticosteroid injections may be coupled with immobilization with a splint; however, immobilization following injections has been associated with increased costs without improved patient outcomes. The addition of exercises may improve relief from steroid injection and splinting.

Conclusions: Our patient had an unusual presentation of De Quervain Tenosynovitis with bilateral radial-sided wrist pain extending to her first four metacarpals. However, her pain was associated with lifting her grandson, and she had bilateral positive Finkelstein test. She experienced significant relief with bilateral corticosteroid injection to her first dorsal extensor compartments. Corticosteroid injections, particularly when guided with ultrasound, may provide significant pain relief to patients with De Quervain Tenosynovitis.