![]() 3 Thickening of the tendon sheath and therefore narrowing of the tunnel occurs because of the presence of fibrocartilage, which is a response to the shear and compression forces placed on the tendons. 4 This tunnel lies over the radial styloid and under the extensor retinaculum, which can cause tendon gliding difficulties and entrapment of the tendons when thickening of the sheath occurs. They lie within a closed fibrous sheath or tunnel with a synovial lining 3 that is approximately 2.2 cm in length. The first dorsal compartment comprises the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL) tendons. 1 The extensor tendons are divided into six compartments as they cross the dorsum of the wrist. The pathophysiology of De Quervain’s tenosynovitis is generally defined in the literature as a stenosing condition of the first dorsal compartment. While the exact cause of De Quervain’s tenosynovitis is still debated, possible aetiologies include acute injuries (eg blunt trauma, biomechanical compression), forceful repetition of the wrist and thumb leading to increased frictional forces or microtrauma (eg workplace-related activity, actions performed by new mothers), inflammatory diseases, anatomical variations, abnormalities of the first dorsal compartment and, rarely, pathogens. 1 The prevalence of De Quervain’s tenosynovitis in adults of working age (18–65 years) in the general population is approximately 1.3% of women and 0.5% of men, with peak prevalence at the age of 40–60 years. Therefore, he has vast experience in performing ultrasound on tenosynovitis and treatment, including injections.While there are many reasons for radial wrist pain, De Quervain’s tenosynovitis is a common pathology and is described as stenosing tenosynovitis of the tendons within the first dorsal compartment of the wrist. He combines working at East Coast Physio, with performing diagnostic ultrasound for several radiology departments based in NHS hospitals. Neil Liffen currently combines his working week as an Extended Scope Physiotherapist and as a Musculoskeletal Diagnostic Sonographer. If you would like further information on diagnosis, treatment and/or management please contact Neil Liffen. Occasionally, it is necessary to perform investigations and ultrasound is a useful early investigation in ruling in or out tenosynovitis and/or other pathology. Due to the complexity of the structures at the wrist diagnosis from physical examination can be challenging. In the majority of cases your symptoms will settle within normal healing times of 6-12 weeks. The other two most commonly injured are the sixth (extensor carpi ulnaris – Figure 2) and second (intersection syndrome) compartments. The first compartment is the most frequently affected site, called De Quervain’s disease. Any of the dorsal compartments of the wrist can develop tenosynovitis. Tenosynovitis is the inflammation of the fluid-filled tendon sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. The wrist is prone to injury, commonly due to trauma, repetitive strain injury and/or through inflammatory conditions, such as rheumatoid arthritis and can cause tenosynovitis. These sheaths reduce the friction to the extensor tendons as they traverse the compartments that are formed by the attachments of the extensor retinaculum to the distal (far end) of the radius and ulna. As the tendons travel over the posterior (back) aspect of the wrist they are enclosed within synovial tendon sheaths. The extensor tendons are held in place by the extensor retinaculum. The extensor tendon compartments are anatomical tunnels on the dorsal wrist and these tendons allow you to predominantly extend (lift up your fingers). Commonly, the dorsal wrist has twelve tendons, divided into six compartments, with some compartments crossing over each other. An example, of the complexity of our anatomy can be demonstrated at the dorsal wrist (back of your hand). In completing a BSc Physiotherapy and MSc Diagnostic Musculoskeletal Ultrasound, Neil has always been fascinated by the human anatomy and learning ligaments, tendons, muscles etc. This time, Neil Liffen, director of East Coast Physio Ltd (ECP) discusses the wrist anatomy with particular emphasis on the back of the hand and common sites of tenosynovitis.
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