Common Hand Conditions: A Review.

Importance: Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and basilar (carpometacarpal) joint arthritis of the thumb can be associated with significant disability. Observations: Carpal tunnel syndrome is characterized by numbness and tingling in the thumb and the index, middle, and radial ring fingers and by weakness of thumb opposition when severe. It is more common in women and people who are obese, have diabetes, and work in occupations involving use of keyboards, computer mouse, heavy machinery, or vibrating manual tools. The Durkan physical examination maneuver, consisting of firm digital pressure across the carpal tunnel to reproduce symptoms, is 64% sensitive and 83% specific for carpal tunnel syndrome. People with suspected proximal compression or other compressive neuropathies should undergo electrodiagnostic testing, which is approximately more than 80% sensitive and 95% specific for carpal tunnel syndrome. Splinting or steroid injection may temporarily relieve symptoms. Patients who do not respond to conservative therapies may undergo open or endoscopic carpal tunnel release for definitive treatment. Trigger finger, which involves abnormal resistance to smooth flexion and extension ("triggering") of the affected finger, affects up to 20% of adults with diabetes and approximately 2% of the general population. Steroid injection is the first-line therapy but is less efficacious in people with insulin-dependent diabetes. People with diabetes and those with recurrent symptoms may benefit from early surgical release. de Quervain tenosynovitis, consisting of swelling of the extensor tendons at the wrist, is more common in women than in men. People with frequent mobile phone use are at increased risk. The median age of onset is 40 to 59 years. Steroid injections relieve symptoms in approximately 72% of patients, particularly when combined with immobilization. People with recurrent symptoms may be considered for surgical release of the first dorsal extensor compartment. Thumb carpometacarpal joint arthritis affects approximately 33% of postmenopausal women, according to radiographic evidence of carpometacarpal arthritis. Approximately 20% of patients require treatment for pain and disability. Nonsurgical interventions (immobilization, steroid injection, and pain medication) relieve pain but do not alter disease progression. Surgery may be appropriate for patients unresponsive to conservative treatments. Conclusions and Relevance: Carpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and thumb carpometacarpal joint arthritis can be associated with significant disability. First-line treatment for each condition consists of steroid injection, immobilization, or both. For patients who do not respond to noninvasive therapy or for progressive disease despite conservative therapy, surgical treatment is safe and effective.

The association between smartphone addiction and thumb/wrist pain: A cross-sectional study.

Many smartphone users experience pain in the thumb/wrist. This pain can be due to certain types of hand injuries as well as inflammation of the extensor pollicis brevis and the abductor pollicis longus tendon sheaths, known as De Quervain tenosynovitis. The objective of this study was to evaluate the association between smartphone addiction and wrist/thumb pain and to determine the severity of the pain, as well as to calculate the prevalence of De Quervain tenosynovitis among medical students at King Abdulaziz University (KAU) in Jeddah.A total of 387 medical students were enrolled. The smartphone addiction scale-short version (SAS-SV) was used to divide participants into the smartphone addict group and non-addict group. Both groups completed the self-administered patient-rated wrist and hand evaluation (PRWHE) questionnaire to evaluate wrist/hand pain. The Finkelstein test was administered to those who reported pain in the thumb/wrist.Two hundred fifty-seven (66.4%) participants were smartphone addicts; 74 (19.1%) had a positive Finkelstein test. There was a significant correlation between smartphone addiction and high PRWHE scores (P = .036).Our study found the prevalence of smartphones addiction among university students to be high (66%), furthermore a correlation between heavy smartphones usage and hand pain was found which indicates that heavy usage of these devices can cause subclinical effects on the human hand.

Relationship between the incidence of de Quervain's disease among teenagers and mobile gaming.

OBJECTIVE: To assess the relationship between the incidence of de Quervain's disease (DD) and mobile gaming. METHODS: We conducted an experimental cross-sectional study and surveyed specialized students with different majors from Xingtai Technician Institute. We applied the stratified clustered sampling method to recruit 500 students aged 16 to 20 years as survey respondents. We diagnosed DD by conducting Finkelstein's test. Chi-square test or Fisher's exact test was used to determine the correlation between different variables and Finkelstein's test results. SPSS 20 statistical software was used to perform all the statistical analyses. RESULTS: Among the five hundred students providing the valid data, there were 302 males and 198 females, with a male-to-female ratio of 3:2. Of them, 216, 159, 77, and 48 reported they played mobile games for < two, two to four, four to six, and > six hours per day, respectively. A total of 246 students (49%) had a positive result in Finkelstein's test. Three hundred and five (61.0%) students played mobile games with their wrist in dorsiflexion position, and among them, 192 had a positive result in Finkelstein's test. The statistical analyses showed that more frequent play, prolonged mobile gaming time per day, and changes in wrist position were significantly correlated with the positive rate of Finkelstein's test (p < 0.05). DISCUSSION: Our results show that the incidence of DD in students in the school was 49.0%. More frequent play, prolonged duration of mobile gaming, and change in wrist position were associated with higher risk of DD. We advocate the restricted time to less than 2.25 hours per day and the frequency in mobile gaming to prevent or reduce DD.

Hand tendinopathy risk factors in Taiwan: A population-based cohort study.

De Quervain's disease, carpal tunnel syndrome (CTS), and trigger finger (digit) are three common pathological conditions of the hand. They are considered overuse syndromes and occur predominantly in females. The prevalence rate and cause-specific risks of these three tendinopathies have not yet been clarified. Data from 41,871 cases listed in the Taiwan National Health Insurance Research Database (NHIRD) from 2010 to 2014 were analyzed. The prevalence rate of these 3 conditions by age, sex, and the risk factors of female-dominant diseases (e.g., osteoporosis, rheumatoid arthritis [RA], and tendinopathy), diabetes mellitus, and hormone antagonist treatment was evaluated. We found that 1.59% of the population developed CTS, 0.49% developed de Quervain's, and 1.07% developed trigger finger. Cases were more likely to develop the three hand tendinopathies if they were female, between 50 and 59 years old, and, according to a multivariate analysis, comorbid with RA, diabetes, using hormone antagonists. Our findings should provide an understanding of the risk factors associated with hand tendinopathy.

Hand Dominance and Common Hand Conditions.

The goals of this study were to (1) assess how frequently patients present for evaluation of common hand disorders in relation to hand dominance and (2) evaluate the effect of hand dominance on function in patients with these conditions. The authors hypothesized that (1) the majority of patients who seek evaluation would have a condition that affects the dominant hand, and (2) disability scores would be worse if the dominant hand is involved. They retrospectively reviewed the records of consecutive patients who presented for treatment to their institution with unilateral symptoms of 5 common disorders of the hand: carpal tunnel syndrome (CTS), de Quervain's tenosynovitis (DEQ), lateral epicondylitis (LE), hand osteoarthritis (OA), and trigger finger (TF). The authors assessed the effect of diagnosis and hand dominance on Disabilities of the Arm, Shoulder and Hand (DASH) scores. The study group comprised 1029 patients (379 men and 650 women) with a mean age of 59.5 years. Ninety percent were right-hand dominant. The dominant and nondominant hands were affected with relatively equal frequency for CTS, DEQ, OA, and TF (range, 45%-53%). Patients with LE had a significantly higher incidence of dominant hand involvement. Men had lower DASH scores than women by an average of 7.9 points, and DASH scores were significantly but slightly higher for the overall group (3.2 points) when the dominant side was affected. Men with LE and women with TF and OA had significantly higher DASH scores when their dominant extremity was affected. Common hand disorders such as CTS, DEQ, OA, and TF affect the dominant and nondominant hands in roughly equivalent proportions, whereas LE is more common on the dominant side. Dominant hand involvement results in significantly worse DASH scores, although the magnitude of this is relatively small. Women have significantly higher DASH scores than men for the conditions evaluated. [Orthopedics. 2016; 39(3):e444-e448.].

Work related etiology of de Quervain's tenosynovitis: a case-control study with prospectively collected data.

BACKGROUND: The etiology of de Quervain's tenosynovitis (dQ) has been based on conflicting small case series and cohort studies lacking methodological rigor. A prospective case-control study was conducted to analyze the most common risk factors for dQ. METHODS: Between January 2003 and May 2011, 189 patients surgically treated for dQ vs. 198 patients with wrist ganglia (WG) (controls) were identified in our clinic's electronic database. Sample characteristics, exertional, anatomical, and medical risk factors were compared between groups. RESULTS: dQ vs. WG differed by average age (52 vs. 43 years) and gender ratio (15/62 vs. 26/39). No significant difference between dQ vs. WG was found after subgrouping professional activities (manual labor: 18 % vs. 26 %, respectively, p = 0.23). No asymmetric distribution of comorbidities, wrist trauma, forceful or repetitive manual work, or medication was observed. CONCLUSIONS: Neither heavy manual labor nor trauma could be shown to be predisposing risk factors for dQ.

Intravitreal injections inducing de quervain tenosynovitis: injector's wrist.

PURPOSE: To describe a case of de Quervain tenosynovitis triggered by the repetitive performance of intravitreal injections. METHODS: Case report of a 32-year-old ophthalmologist. RESULTS: The ophthalmologist experienced de Quervain tenosynovitis while performing 425 intravitreal injections a month. These were predominantly performed in condensed sessions (injection clinics). Symptoms resolved with nonsurgical management. CONCLUSION: The repetitive performance of intravitreal injections may be an unrecognized occupational hazard for ophthalmologists.

Upper limb musculoskeletal complaints among technicians working in a diagnostic tuberculosis laboratory: two case reports.

Upper limb musculoskeletal complaints are common among certain health professionals. We report two cases, both involving technicians working in a diagnostic tuberculosis laboratory in Hong Kong. A work process evaluation suggest that the need to repeatedly open and close small bottles, as well as to work for prolonged periods of time in confined areas, could be related to the workers' clinical presentation. The cases are also compatible with the diagnosis of repetitive strain injury (RSI) of the upper limb, but this term is not commonly used nowadays because of various definitional issues. A review of the various diagnostic issues in RSI is presented.

Acupuncture in De Quervain's disease: a treatment proposal.

De Quervain's disease is a painful stenosing tenosynovitis of the first dorsal compartment of the hand affecting the tendons of the abductor pollicis longus and extensor pollicis brevis, caused mainly by overuse. Conventional treatments include rest, immobilisation, oral anti-inflammatory drugs, corticosteroid injection and even surgery, but none of these is established as clearly effective. Acupuncture is rarely mentioned and the points suggested are rather general-regional, tender and ah shi points. Tendinopathy is almost always associated with problems in the relevant muscles and this paper calls attention to the correct identification and needling of the affected muscles, in order to increase the specificity of acupuncture treatment.

Systematic review and meta-analysis on the work-related cause of de Quervain tenosynovitis: a critical appraisal of its recognition as an occupational disease.

BACKGROUND: The authors systematically reviewed all of the etiopathologic factors discussed in the literature to verify the classification of de Quervain tenosynovitis on the list of occupational diseases. METHODS: The authors searched Ovid MEDLINE, EMBASE, and the Cochrane Library for articles discussing the cause of de Quervain tenosynovitis. The literature was classified by the level of evidence presented, the etiopathologic hypothesis discussed, the authors' conclusion about the role of the etiopathologic hypothesis, and the first author's professional background. The quality of reporting of the observational studies was evaluated by an extended Strengthening the Reporting of Observational Studies in Epidemiology statement checklist. A meta-analysis of all controlled cohort studies was performed. The Bradford Hill criteria were used to evaluate a causal relationship between de Quervain tenosynovitis and occupational risk factors. RESULTS: A total of 179 references were found, and 80 articles were included. On average, only 35 percent (median, 35 percent; range, 16 to 60 percent) of all items on the extended Strengthening the Reporting of Observational Studies in Epidemiology checklist were addressed per article. The meta-analysis to evaluate the strength of the association between de Quervain tenosynovitis and (1) repetitive, (2) forceful, or (3) ergonomically stressful manual work suggested an odds ratio of 2.89 (95 percent CI, 1.4 to 5.97; p = 0.004). No evidence was found to support the Bradford Hill criteria for a causal relationship between de Quervain tenosynovitis and occupational risk factors. CONCLUSION: No sufficient scientific evidence was provided to confirm a causal relationship between de Quervain tenosynovitis and occupational risk factors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Adoption of preventive measures after returning to work among workers affected by De Quervain's tenosynovitis.

OBJECTIVES: To determine whether if there was any increase in preventive measures adopted following reincorporation to their jobs among workers affected by De Quervain's tenosynovitis (DQT), who were treated by surgical intervention. METHODS: Study subjects where those workers, members of a mutual health insurance scheme, who were operated on between June 2006 and June 2009 (n=52). For each worker we checked whether preventive measures had been taken in their workplace, both before their episode, and following reincorporation. The difference in proportions (DP) was calculated between the proportion of individuals with preventive measures after reincorporation and the proportion with preventive measures implemented prior to their surgical intervention, both globally and in terms of sociodemographic, occupational, and clinical variables. RESULTS: The proportion of workers with preventive measures adopted following reincorporation to their job was higher than the proportion with preventive measures prior to their surgical intervention (DP = 23.1 %; 95 %CI: 6.4-39.7 %). The risk factors associated with the greatest change in preventive measures were repetitive movements (DP = 25.6 %; 95 %CI: 6.1-45.1 %) and awkward postures (DP = 40 %; 95 %CI: -22.9 to 100 %). CONCLUSIONS: Despite the increased proportion of workers with preventive measures implemented in their workplace following reincorporation to the job, there is a lack of information and of adoption of ergonomic preventive measures specific to this pathology. Implementation of ergonomic programs could reduce incidence of musculoskeletal disorders such as DQT, and would thus increase productivity, efficiency and worker satisfaction, while diminishing sick leave episodes, and the associated costs and relapses.

Hand pain other than carpal tunnel syndrome (CTS): the role of occupational factors.

Some occupational factors have been implicated in the development of disorders manifested as hand pain. The associations seem to be well documented in processes such as hand-arm vibration syndrome (HAVS) or writer's cramp. There are contradictory data in the literature about the relationships of trigger finger, De Quervain's tenosynovitis (DQT) and tenosynovitis of the wrist with occupational factors. In this article, we review current knowledge about clinical manifestations, case definition, implicated occupational factors, diagnosis and treatment of the most relevant hand pain disorders that have been associated with occupational factors, excluding carpal tunnel syndrome (CTS).

Tenosynovitis caused by texting: an emerging disease.

De Quervain tenosynovitis is characterized by pain that overlies the radial aspect of the wrist and that is aggravated by ulnar deviation of the hand. The most common cause of de Quervain tenosynovitis is overuse of the thumb musculature. The authors report a case of bilateral de Quervain tenosynovitis observed in a woman aged 48 years at a rural outpatient primary care office. The condition was induced by the patient's excessive use of the text messaging feature on her cellular telephone. Treatment, including naproxen, cock-up wrist splints, and limitation of texting, resulted in complete recovery of the patient. The authors urge physicians to be aware of the potential association between a patient's tenosynovitis symptoms and excessive texting.

Effectiveness of interventions of specific complaints of the arm, neck, and/or shoulder: 3 musculoskeletal disorders of the hand. An update.

OBJECTIVES: To provide an evidence-based overview of the effectiveness of conservative and surgical interventions for trigger finger, Dupuytren's, and De Quervain's diseases. DATA SOURCES: The Cochrane Library, PEDro, PubMed, Embase, and CINAHL were searched to identify relevant studies. STUDY SELECTION: Two reviewers independently applied the inclusion criteria to select potential relevant studies from the title and abstracts of the references retrieved by the literature search. Relevant (Cochrane) reviews and randomized controlled trials (RCTs) were included. DATA EXTRACTION: Two reviewers independently extracted the data and performed a methodologic quality assessment. DATA SYNTHESIS: A best-evidence synthesis was performed to summarize the results of the included trials. One Cochrane review (trigger finger) and 13 RCTs (trigger finger [6], Dupuytren's [4], De Quervain's [3]) were included. The trials reported on physiotherapy (De Quervain's), steroid injections (trigger finger, De Quervain's), surgical treatment (trigger finger, De Quervain's), and a postsurgical treatment (Dupuytren's). For trigger finger, moderate evidence was found for the effectiveness of steroid injections in the short-term (1-4 wk) but not for long-term outcomes. Limited evidence was found for the effectiveness of staples compared with sutures in skin closure and for intermittent compression after surgery to treat Dupuytren's disease. For other interventions, no evidence was found. CONCLUSIONS: Indications for effectiveness of some interventions for trigger finger, Dupuytren's, and De Quervain's diseases were found. Because only a few RCTs were identified, it is difficult to draw firm conclusions. High-quality RCTs are clearly needed in this field.