The patient, usually a middle-aged woman, has difficulty
with tasks like opening jars because of pain at the base of
the thumb, which may also be present upon awakening. On
examination, there is little or no swelling and no
deformity, just tenderness on palpating or stretching the
extensor pollicis brevis and abductor pollicis longus
tendons bordering the palmar side, or less commonly, the
extensor pollicis longus tendon bordering the dorsal side of
the anatomic snuffbox.
What to do:
Document normal circulation, sensation, movement. Compress
the thumb metacarpal onto the scaphoid to see if it is fractured. Look for carpal tunnel syndrome with Phalen's test.
Have the patient fold the thumb into the palm, close the
fingers over it into a fist, then ulnar deviate the wrist. This
is known as the Finklestein test, and reproduces the pain of
DeQuervain's tenosynovitis of the extensor pollicis brevis and
abductor pollicis longus tendons.
Presecibe anti-inflammatory analgesics and a radial gutter
splint to immobilize the thumb to the intraphalangeal joint.
