Anatomy
The tendons around the wrist are surrounded by tendon sheaths. The tendons on the dorsal aspect of the wrist are arranged in 6 courses (see image) and are held in tendon sheaths that are attached to the bones. The tendons on the palm side of the wrist lie in one compartment (carpal tunnel) and are held by a strong, transverse connective tissue structure (retinaculum flexorum). The tendons in the 1st joint contribute to the movement of the thumb (M. abductor pollicis longus and M. extensor pollicis brevis).
Tendon sheaths on the back of the hand:
A. Retinaculum extensorum
B. Vagina tendinum mm. abductoris longi et extensoris pollicis brevis (1)
C: Vagina tendinum mm. extensorum carpi radialium (2)
D. Vagina tendinis m. extensoris pollicis longi (3)
E. Vagina tendinum mm. extensoris digitorum et extensoris indicis (4)
F. Vagina tendinis m. extensoris carpi ulnaris (6)
G. Vagina tendinis m. extensoris digiti minimi (5)
Cause of the problem
Tendinitis and tenosynovitis of the tendons on the wrist is caused by mechanical irritation of the tendon and tendon sheath due to repetitive, repetitive movements (e.g. racquet sports and golf), resulting in ‘inflammation’, often accompanied by swelling. All tendons and tendon sheaths around the hand can be affected.
Tendonitis in the 1st joint (thumb) is called De Quervans syndrome and is the most common site of tendon and tendonitis around the hand.
Symptoms
Slow onset of pain along the strained tendon (sheath). The area may occasionally feel swollen and crackling when moving the finger. The pain in the 1st rib (De Quervans syndrome) is aggravated when twisting a cloth and when the thumb is moved away from the index finger against resistance (abduction).
Examination
The diagnosis is usually made by clinical examination, where there is tenderness and occasional swelling of the overloaded tendon (sheath). If there is doubt about the diagnosis, an ultrasound scan can be performed, where the impact on the tendon, fluid in the tendon sheath and inflammation in the tendon sheath and possibly tendon (blood vessel ingrowth, Doppler activity) can be seen (Fakoya AO, et al. 2023).
The 2nd buttock includes the extensor carpi radialis longus and extensor carpi radialis brevis muscles. Tendonitis and tendinitis of the 2nd buttock (intersection syndrome) is a differential diagnosis for De Quervans syndrome (1st buttock) (although the treatment is largely the same).
Treatment
Treatment primarily involves relief from pain-inducing activity, stretching and slowly increasing strength training within the pain threshold of the muscles around the wrist. If relief is not successful, rehabilitation can be supplemented with medical treatment in the form of arthritis pills (NSAIDs) or ultrasound-guided injection of adrenal cortex hormone into the tendon sheath (He KS, et al. 2023). Surgery is rarely indicated.
Bandage
Using a wrist splint for a short period of time will often relieve the injury, for example if you have to strain your wrist for work.
Complications
If no progress is made, consider whether the diagnosis is correct or if complications have arisen:
In particular, the following should be considered:
- Fracture of the boat bone in the wrist
- Degenerative arthritis in the hand
- Discus triangularis
- Intersection syndrome or arthritis disease of the wrist
