Information
- Inflammation of tendons and synovial sheaths of APL and EPB
Causes
- Repetitive friction |
- Microtrauma |
- Lifting, grasping and pinching with wrist radial or ulnar deviation (causes tendons to rub against radial styloid process) |
- Gardening, knitting, cooking, playing a musical instrument, carpentry, walking a pet, texting, video gaming, sports (golf, volleyball, fly fishing, racquet sports, excessive mobile use |
- Lifting children/babies |
- Diabetes |
- RA |
- Pregnancy (changes in oestrogen) |
- Women more than men |
- Black people affected more than other races |
- Extra defect - intracompartmental septum |
Presentation
- Pain lateral aspect of wrist but can move towards brachioradialis |
- Pain may begin gradually/abruptly |
- Pain aggravated by movements of the thumb/hand (forceful pinching/grasping/twisting) |
- Swelling over EPB and APL tendons |
- "Squeaking" sound with movement of the wrist |
- Catching/snapping can occur |
- Numbness over dorsal thumb and index finger |
- Tenderness over first dorsal compartment (radial styloid process) |
- Decreased ROM of thumb (resisted thumb extension painful) |
- Diminished pinch grip (Determine from CTS) |
- +ve Finkelsteins |
- If intracompartmental septum +ve EPB entrapment test |
Imaging
- Ultrasound |
- MRI only if red flags are present (Hx of trauma, systemic signs, failed conservative care) |
DDx
- Intersection syndrome |
- OA of the 1st CMC |
- Thumb sprain |
- Ganglion cyst |
- Distal radial nerve entrapment |
- Cervical Radiculopathy |
Management
- US |
- Laser |
- Cryotherapy |
- NSAIDs |
- Rest (avoid activities that provoke pain, take frequent breaks) |
- Splinting? |
- Stretching of APL, EPB, wrist flexors, extensors, brachioradialis |
- Myofascial release of first dorsal compartment, wrist extensors, brachioradialis |
- SMT of wrist, Cx |
Poor prognosis factors: Pain score >8/10, involvement of sensory branch of the radial nerve, inability to tolerate NSAIDs, inability/unwilligness to perform home therapy and implement changes in ADLs, Severe swelling over 1st dorsal compartment, presence of intracompartmental septum |
- Surgery if conservative treatment or injection fails |
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