Authors: Fiona Mendes / Editor: Yasmin Sultan / Reviewer: Fiona Mendes / Codes: / Published: 28/08/2019
A 34-year-old pregnant female attends your Emergency Department (ED) Minor Injuries Unit with her three playful young toddlers. She is right hand dominant.
She complains that she can no longer use her hands, particularly her right hand to write with and finds it difficult to perform her usual activities of daily living due to pain along and beneath her thumbs. She was previously seen by her GP diagnosed with a sprain as the pain was initially only in the right hand and exacerbated after playing tennis. Her pain on movement is getting worse despite taking analgesia. She cannot recall any direct trauma. She is otherwise fit and well, and tells you she has a busy lifestyle looking after her young children and working as a part-time secretary. Her hobbies include piano-playing, knitting baby clothes and she enjoys playing video games with her children.
On examination of both upper limbs, there are no bruises or open wounds. She has otherwise normal range of movement in her fingers, wrist, elbows and shoulders. Pain is exacerbated on movement of the thumbs and wrists. Both upper limbs are neurovascularly intact. Sensation to radial, medial and ulnar nerves are intact, normal to light touch. There is no bony tenderness.
Radiographs of both hands requested at triage appear normal with no fractures seen.
After further examination, you suspect that this patient has de Quervains tenosynovitis.
