| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 895.61 KB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
Introdução: A tenossinovite de De Quervain é uma tendinopatia comum que causa
morbilidade significativa por limitação do uso da mão afetada. A dor no lado radial do pulso é
o sintoma prevalente e é devida ao deslizamento resistido dos tendões presentes no primeiro
compartimento extensor do punho. Surge em adultos ativos com predomínio no sexo feminino.
O seu diagnostico é feito na maioria das vezes através da clínica, sendo o teste de
Finkelstein considerado patognomónico desta patologia. Contudo, este teste apresenta uma
elevada taxa de falsos-positivos e por isso o uso da ecografia oferece mais segurança e uma
melhor caracterização do estadio da doença.
A modalidade terapêutica mais eficaz não está bem estabelecida, explicando a elevada
taxa de recidivas, podendo o quadro arrastar-se e passar a crónico. Por isso, é importante criar
uma diretriz de tratamento para ajudar na implementação de melhores práticas, na formação
de profissionais de saúde e na identificação de lacunas no conhecimento existente.
Objetivos: Esta revisão bibliográfica pretende reunir e rever a informação existente
sobre a tenossinovite de De Quervain para encontrar a abordagem terapêutica mais eficaz e
avaliar o papel da ecografia no diagnóstico diferencial, na identificação de variações
anatómicas e de pistas que possam orientar o tratamento.
Metodologia: Para a realização desta dissertação foi realizada pesquisa bibliográfica e
efetuada revisão de literatura científica através da utilização das plataformas PubMed,
UpToDate e ScienceDirect.
Conclusões: Conclui-se que a ecografia apresenta um papel bastante importante não
só para confirmar o diagnóstico, como para identificar as diversas variações anatómicas
existentes no primeiro compartimento extensor do punho, muito frequentes neste tipo de
patologia, sendo também importante no diagnóstico diferencial e no seguimento de todo o
processo. Além disso, a ecografia é indispensável na realização de infiltrações com
corticosteróides, uma das alternativas terapêuticas.
Quanto à abordagem terapêutica, foi desenvolvida uma proposta de diretriz
terapêutica, que consiste no tratamento hierárquico consoante a duração e a
gravidade/sintomas que o doente apresenta, esta foi adaptada do “European Handguide Study”
e complementada com a restante pesquisa bibliográfica.
No entanto, esta abordagem fornece apenas uma orientação terapêutica, mantendo a
flexibilidade para se adaptar a situações particulares, sendo a decisão sempre compartilhada e
explicada com o paciente. Conclui-se também que é essencial futuras pesquisas sobre esta
temática devido à falta de estudos controlados de alta qualidade.
Introduction: De Quervain's tenosynovitis is a common tendinopathy that causes significant morbidity due to the limited use of the affected hand. Pain on the radial side of the wrist is the prevalent symptom and is due to the resisted sliding of the tendons present in the first extensor compartment of the wrist. It appears in active adults with a predominance of females. Its diagnosis is made most of the times through the clinic, being the Finkelstein test considered pathognomonic of this pathology. However, this test has a high rate of false positives and therefore the use of ultrasound offers more security and better characterization of the stage of the disease. The most effective therapeutic modality is not well established, explaining the high rate of recurrences, and the condition can drag on and become chronic. For this reason, it is important to create a treatment guideline to help implement best practices, train health professionals and identify gaps in existing knowledge. Objectives: This bibliographic review aims to gather and review the existing information on De Quervain's tenosynovitis to find the most effective therapeutic approach and to evaluate the role of ultrasound in the differential diagnosis, in the identification of anatomical variations and clues that may guide the treatment. Methodology: For this study, a bibliographic research and literature review was carried out, mainly using PubMed, UpToDate and ScienceDirect platforms. Conclusions: It is concluded that ultrasound has a very important role not only to confirm the diagnosis, but also to identify the various anatomical variations existing in the first extensor compartment of the wrist, very common in this type of pathology, being also important in the differential diagnosis and in the monitoring of the entire process. In addition, ultrasound is essential to perform infiltrations with corticosteroids, one of the therapeutic alternatives. As for the therapeutic approach, a proposal for a therapeutic guideline was developed, which consists of hierarchical treatment according to the duration and severity / symptoms that the patient presents, this was adapted from the “European Handguide Study” and complemented with the rest of the bibliographic research. However, this approach provides only therapeutic guidance, maintaining the flexibility to adapt to particular situations, and the decision is always shared and explained with the patient. It is also concluded that future research on this topic is essential due to the lack of high-quality controlled studies.
Introduction: De Quervain's tenosynovitis is a common tendinopathy that causes significant morbidity due to the limited use of the affected hand. Pain on the radial side of the wrist is the prevalent symptom and is due to the resisted sliding of the tendons present in the first extensor compartment of the wrist. It appears in active adults with a predominance of females. Its diagnosis is made most of the times through the clinic, being the Finkelstein test considered pathognomonic of this pathology. However, this test has a high rate of false positives and therefore the use of ultrasound offers more security and better characterization of the stage of the disease. The most effective therapeutic modality is not well established, explaining the high rate of recurrences, and the condition can drag on and become chronic. For this reason, it is important to create a treatment guideline to help implement best practices, train health professionals and identify gaps in existing knowledge. Objectives: This bibliographic review aims to gather and review the existing information on De Quervain's tenosynovitis to find the most effective therapeutic approach and to evaluate the role of ultrasound in the differential diagnosis, in the identification of anatomical variations and clues that may guide the treatment. Methodology: For this study, a bibliographic research and literature review was carried out, mainly using PubMed, UpToDate and ScienceDirect platforms. Conclusions: It is concluded that ultrasound has a very important role not only to confirm the diagnosis, but also to identify the various anatomical variations existing in the first extensor compartment of the wrist, very common in this type of pathology, being also important in the differential diagnosis and in the monitoring of the entire process. In addition, ultrasound is essential to perform infiltrations with corticosteroids, one of the therapeutic alternatives. As for the therapeutic approach, a proposal for a therapeutic guideline was developed, which consists of hierarchical treatment according to the duration and severity / symptoms that the patient presents, this was adapted from the “European Handguide Study” and complemented with the rest of the bibliographic research. However, this approach provides only therapeutic guidance, maintaining the flexibility to adapt to particular situations, and the decision is always shared and explained with the patient. It is also concluded that future research on this topic is essential due to the lack of high-quality controlled studies.
Description
Keywords
Ecografia da Mão e do Punho Infiltração de Corticosteroides Guiada Por Ecografia Tendinopatia Tenossinovite de de Quervain Variações Anatómicas