De Quervain's Tenosynovitis

Patienten-Zusammenfassung

Ist dies FDA-zugelassen fuer diese Anwendung?

Not FDA-cleared for de Quervain tenosynovitis. FDA cleared medicinal leeches only for venous congestion in microsurgical reconstruction (K040187, 2004). Use here is investigational.

Welche Evidenz existiert?

Tier C (investigational). There are no published controlled trials. Evidence-based care: thumb spica splinting (the strongest non-operative evidence), NSAIDs, activity modification (avoiding repetitive thumb abduction and ulnar deviation), local corticosteroid injection (the highest-evidence single intervention - cure rate around 80 percent), and (refractory) surgical release of the first dorsal compartment. New onset in postpartum women (mommy thumb) usually responds well to splinting and corticosteroid injection.

Hauptrisiken

• Bleeding from each bite site for 6 to 24 hours after detachment
• Bruising over the radial wrist for 5 to 10 days
• Local skin or, rarely, Aeromonas hydrophila infection
• Allergic reaction to leech saliva (uncommon)
• RISK if leech is placed over the radial artery or radial sensory nerve
• Worsening tendon pain from local irritation
• Delay of thumb spica splinting and corticosteroid injection - which have the strongest evidence

Wer dies nicht in Betracht ziehen sollte

• Patients who have not tried thumb spica splinting for at least 4 to 6 weeks
• Patients who have not tried corticosteroid injection (the highest-evidence single intervention)
• Patients with intersection syndrome, CMC arthritis, or radial sensory neuritis mimicking de Quervain
• Patients on anticoagulants, with hemophilia, or with severe anemia
• Patients with active dermatitis or broken skin over the radial wrist
• Patients with peripheral vascular disease affecting the wrist

Was Sie Ihren Kliniker fragen sollten

• Have we confirmed de Quervain tenosynovitis with Finkelstein or Eichhoff testing?
• Have we ruled out intersection syndrome, CMC arthritis, and radial sensory neuritis?
• Have I tried a thumb spica splint for at least 4 to 6 weeks?
• Have I tried corticosteroid injection - the highest-evidence single intervention?
• Am I a candidate for surgical release of the first dorsal compartment if conservative care fails?
• Where exactly will the leech be placed - confirm placement avoids the radial artery and radial sensory nerve?
• What is the Aeromonas-prevention protocol?

Wann dringende medizinische Versorgung suchen

• Sudden severe pain with inability to grip or move the thumb (possible tendon rupture)
• Numbness, tingling, or hypersensitivity on the dorsal radial hand (possible radial sensory neuritis)
• Acute swelling, severe pain, or cold pallor of the hand or wrist
• Bleeding from a bite site lasting more than 24 hours
• Fever, chills, or spreading redness at the bite site
• Hives, facial or throat swelling, or breathing difficulty