De Quervain tenosynovitis — SCE Rheumatology MCQ

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EasyOsteoarthritis and Soft Tissue RheumatologyDe Quervain tenosynovitisSCE Rheumatology

A 34-year-old woman has radial wrist pain 3 months after childbirth. Pain is worse lifting her baby and Finkelstein test is positive. There is no synovitis of the MCP joints and inflammatory markers are normal. What is the most likely diagnosis?

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Correct answer: D — De Quervain tenosynovitis

Explanation lettering: D = shown as A · E = shown as B · A = shown as D · B = shown as E

De Quervain tenosynovitis is best because postpartum radial wrist pain with positive Finkelstein test indicates De Quervain tenosynovitis. B is less suitable because carpal tunnel causes median nerve paraesthesia; C is less suitable because first CMC OA causes thumb-base bony pain and is less likely postpartum; D is less suitable because RA would produce inflammatory synovitis; E is less suitable because intersection syndrome pain is more proximal on the dorsal forearm. Clinical pearl: the first dorsal extensor compartment is the anatomical site tested here.

Reference: Oxford Textbook of Rheumatology