Video
Definition
Stenosing Tenosynovitis of 1st dorsal compartment of wrist
Aetiology
Epidemiology
- Most are middle-aged women
- Can develop in any with repetitive thumb abduction & extension combined with RD & UD movements
- Results from any mechanical irritation of foreign body, prominent bony surface, restricted fascial comp or abnormal muscle insertion to epitenon
Associated Conditions
- DM
- Pregnancy
- Hypothyroidism
- Gout
- Pseudogout
- RA
- Osteoarthritis
- PostTrauma
- TB
- Vascular disease
Anatomy
- 1st dorsal compartment runs over styloid process
- Runs in osteoligamentous tunnel of shallow groove in styloid & roofed by dorsal ligament attached by fibrous septa to bone
- Tunnel ~ 1cm long
- 1x APL & 1x EPB in only 20%
- 20-30% divided by vertical septa into 2 comps
- Ulnar for EPB
- Other for one or more slips of APL
- EPB phylogenetically young muscle
- Found only in humans & gorillas as separate from APL
- EPB absent 5-7%
- Larger APL has (up to 75%) 2-3 or more tendinous slips inserting variously into
- Base of 1st MC
- Trapezium
- Volar carpal ligament
- Opponens pollicis
- APB
Pathology
Classification
History
Examination
- Pain & swelling over styloid
- May radiate proximal & distal
- Finkelstein’s test +ve
- Crepitus
- Occasionally see triggering
- RD posture
- May have Bone Scan +ve
Investigations
Differential Diagnosis
- Basilar thumb arthrosis
- Scaphoid nonunion
- Intersection syndrome (ECRL/B crossed by APL & EPB)
- Wartenberg’s Syndrome (compression superficial branch radial n)
Treatment
Non-op
- Rest & Splint
- HCLA
- Harvey 71% relief with 1x injection
- Only 11% need surgery
- Prolonged conservative Treatment if condition involves pregnancy, DM etc
Operative
- Transverse or Longitudinal incision
- Blunt dissection to expose Superficial Radial Nerve
- Divide Annular Ligament » ensure all compartments decompressed
Complications
- Very Common
- 2 papers ~ 100%
- Radial n neuroma/ division
- Hypertrophic scar from longitudinal incision
- Volar subluxation of tendon if remove too much sheath