Inflammation of the tendon sheath on the outer wrist
INFLAMMATION OF THE TENDON SHEATH ON THE OUTER WRIST
INFLAMMATION OF THE TENDON SHEATH ON THE OUTER WRIST (Tenosynovitis styloideae radii, De Quervain)
Anatomy:The tendons around the wrist are surrounded by tendon sheaths, as are the tendons located externally (radial) on the wrist which contribute to the movement of the thumb (M abductor pollicis longus and M extensor pollicis brevis).
Vagina tendinum mm. abductoris longi et extensoris pollicis brevis (1)
Vagina tendinum mm. extensorum carpi radialium (2)
Vagina tendinis m. extensoris pollicis longi (3)
Vagina tendinum mm. extensoris digitorum et extensoris indicis (4)
Vagina tendinis m. extensoris carpi ulnaris (6)
Vagina tendinis m. extensoris digiti minimi (5)
TENDON SHEATHS ON THE BACK OF THE HAND
Cause: Inflammation of the tendon sheath (tenosynovitis) occurs as a result of mechanical irritation of the tendon sheath due to repeated uniform movements of the tendon, causing the tendon to become inflamed and swell (article).
Symptoms: Slowly commencing pain along the wrist on the side of the thumb. The area can occasionally feel swollen, and crackling sensation felt upon movement of the thumb. The pain deteriorates when twisting a rag, and when the thumb is moved away from the index finger against resistance.
Examination: Slight cases do not necessarily require medical examination. The doctor should be consulted if there is lack of progress despite relief. The diagnosis is usually made from a normal medical examination, however, in the event of doubt in connection with the diagnosis an ultrasound scan can be performed which will easily and quickly detect the inflammation (Ultrasonic image)(article).
Treatment: The treatment primarily involves relief, stretching and strength training of the muscles around the wrist. It is imperative for the treatment that the triggering load factor is reduced (article). In cases with a lack of progress following relief, a medical treatment can be considered in the form of rheumatic medicine (NSAID) or the injection of corticosteroid in the tendon sheath. Since the effect and the risk is dependant on the injection being performed correctly, the injection can advantageously be executed under ultrasound guidance. Surgery is rarely indicated.