1. What are some differentials to consider?
1.1. CTS
1.2. arthritis
1.3. scaphoid fx
2. What are some pertinent + and -?
2.1. ask about specific hobbies/occupation
2.1.1. use of pinch-grip activities
2.1.1.1. carrying trays with pinch grip
2.1.1.2. assembly work
2.1.1.3. sewing/cutting activities
2.2. pain at radial side of wrist
2.2.1. with lifting
2.2.1.1. aggravated by moving thumb/making fist
2.2.2. pain with turning doorknob
2.2.3. pain with opening a jar
2.2.4. lifting infants
2.2.4.1. with second metacarpal
2.2.4.1.1. under baby's axillae
3. What are the objective findings?
3.1. do same tests as with CTS
3.1.1. negative
3.1.1.1. Allen
3.1.1.2. Phalen
3.1.1.3. Tinel
3.2. tendon sheath may feel thickened
3.3. + Finkelstein
3.3.1. procedure
3.3.1.1. touch thumb into palm
3.3.1.2. make fist
3.3.1.2.1. pain
4. What is the management plan?
4.1. Rest
4.2. Splinting
4.2.1. radial gutter
4.2.2. custom long oppens
4.2.3. 3-6 wks
4.2.4. should also immobilize wrist
4.3. NSAIDs
4.4. corticosteroid injection
4.4.1. experienced provider
4.4.2. orthopedist
4.5. F/U
4.5.1. 6-8 wks
4.5.1.1. no improvement
4.5.1.1.1. refer to orthopedist
4.6. Education
4.6.1. modification to tools
4.6.2. avoidance of trigger factors
5. What is it?
5.1. APL and extensor pollicis brevis tendons exert excessive friction on their synovial sheath causing inflammation.
5.2. pain at the base of the thumb or radial styloid process
5.2.1. with abduction and extension of the thumb
6. What causes it?
6.1. more common in middle aged women
6.1.1. from repetetive use of the thumb
6.2. inflammation of the synovial tunnel
6.2.1. opening of canal narrows
6.2.1.1. causing stenosis
6.2.1.1.1. pain when tendons move
7. Anything else I need to order?
7.1. hx of trauma
7.1.1. order xray