A 42-year-old carpenter presents with wrist pain and grip weakness

A 42-year-old carpenter presents with wrist pain and grip weakness. On exam, he is found to have pain over the radial aspect of the wrist that is aggravated by flexing the thumb and applying ulnar flexion. The most likely diagnosis is
A) Carpal tunnel syndrome
B) Scaphoid fracture
C) de Quervain’s tenosynovitis
D) Boxer’s fracture
E) Hamate fracture


Answer and Discussion

The answer is C. de Quervain’s tenosynovitis

The combination of wrist pain and grip weakness is characteristic of de Quervain’s tenosynovitis. Local tenderness is present over the distal portion of the radial styloid adjacent to abductor pocillis longus tendon. The pain is generally reproduced with direct palpation of the involved tendons. Pain is aggravated by passively stretching the thumb tendons over the radial styloid in thumb flexion (the Finkelstein maneuver).
Carpal tunnel syndrome will present with parathesia and/ or weakness primarily in the distribution of the median nerves—thumb and index finger.
A scaphoid fracture presents with mild, dull pain, deep in the radial wrist that is worsened when making a grip. On exam, there is tenderness to palpation in the anatomical “snuff box”—this is a sensitive, but not specific test.
A boxer’s fracture refers to a fracture of the midshaft of the 5th metacarpal (typically following a blow with a closed fist).
A hamate fracture presents with pain along the ulnar side of the hand and is frequently seen in sports that require swinging of bats or racquets