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Thursday, December 27, 2018

De Quervain's like Pain After CPR

Yesterday I was demonstrating CPR in a life support workshop. Today, I have pain in the left radial styloid process area.

What could it be? Searching took me to two pages of interest. One is AAFP's page on diagnosis wrist pain. This page talks about many things including Finkelstein's test which is grasping the thumb with other fingers and then ulnar deviation of wrist. It was negative for me, and I definitely did not have De Quervain's tendonitis.

But it could be the same tendons. What are the tendons involved in de Quervain's? The extensor policis brevis and the abductor policis longus which both go through the groove lateral to the radial styloid process. Maybe there was some microtrauma?

The other article was about wrist injuries in emergency service providers. It does not look like I have a scapholunate ligament injury. So I decided to read more about de Quervain's.

I found an article - Walsh and Miller: Pain about the Styloid Process - which beautifully captures the history of Fritz de Quervain's initial case descriptions and then Finkelstein's reviews and so on. The original articles by de Quervain are probably in German (Because Google Translate detects the title so. I initially thought they were in French because I had once enrolled to learn French in Alliance Francaise and it looked similar to what I was learning then). You can, though, read translations in English if you, like me, can't tell between French and German - references 1-4 on this article.

Especially the one "on a form of chronic tendovaginitis". When you read this you find out how chronic inflammations of tendon sheath were "rightly, increasingly being seen as tubercular". And then de Quervain going on to describe a chronic inflammation due to repeated use. The people who see beyond what they are taught to see indeed get diseases named after them.

Wait a second, where did "vagina" come into picture? Why is it tendovaginitis? Well, as it turns out, vagina means sheath in latin (and the sword (gladius) is kept inside) and since the inflammation here is on the sheath around the tendons, de Quervain (who obviously is a master of language) named it tendovaginitis. In fact, I see all reference of tendovaginitis going back to de Quervain's disease. [Side note: Do you still want to use the word vagina to refer to vagina? Are you sure you are talking about vagina, and not labia or vulva?]

After all that research, now I am now thinking it is the skin over the forearm that is giving me pain as the pain increases when I am softly rubbing over the skin. Maybe it is just a friction burn I got when handling my bag?

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