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Information Sheet for Candidates

A 45 year old waiter, John, comes to you for a flu injection and he mentions that he has
increasing difficulties with his job, carrying heavy trays, his right hand does not seem to
be strong enough anymore and he wonders if you can help him with that as well as with
the flu injection.

How do you respond to the patient’s request?

crackling). pinching. aspirin and naprosyn 3. FEEL !!!!): The area over the abductor pollicis longus and extensor polllicis brevis tendons may be swollen and tender at the side of the wrist. EXAMINATION: (LOOK. A sharp pain will be elicited over the radial side of the wrist and suggests that the problem is due to DeQuervain’s tenosynovitis. anti-inflammatory medications such as neurofen. Actually there had been a change of practice at his workplace where he now has to perform a twisting motion with his right wrist on a regular basis. which further prevents the smooth gliding action of the tendons within the tunnel. He finds working as a waiter more and more difficult. In advanced cases a creaking or grating noise can be heard over the affected area and also listened to with a stethoscope. leading to inflammation of the tendons and the synovium. sometimes he has almost dropped a tray when he carried a heavy load on it because of sudden pain in the wrist and he wonders if something could be done to ease the pain. surgery by splitting the tendon sheath .HISTORY: Over the last 6 months john noticed slightly increasing pain on the thumb side of his right wrist with the pain now spreading up the forearm and down into the thumb. squeezing or wringing. Immobilise the wrist in a neutral position with a splint and avoid aggravating movements. CAUSES: 1. repetitive activities such as grasping. The “Finkelstein” test is used to confirm the diagnosis: it is performed by grasping the affected thumb between fingers and bending the wrist away from the thumb or pulling the thumb actively towards the small finger. Ice packs help especially in the acute phase. This leads to swelling. LISTEN. 2. He can feel a “creak” when moving the thumb (crepitus. 2. grating. some forms of arthritis TREATMENT OPTIONS: 1. Injury to the area 3. which covers the tendons. local injection of anti-inflammatory and anaesthetic drugs 4.