From the Guidelines
Extensor compartment tenosynovitis should be diagnosed using MRI, as it is useful for diagnosing infectious and noninfectious tenosynovitis in both the flexor and extensor wrist compartments. Treatment typically begins with conservative measures including rest, ice, and anti-inflammatory medications such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, as recommended by general medical guidelines 1.
Key Considerations
- Immobilization with a thumb spica splint worn continuously for 2-6 weeks is recommended to rest the affected tendons.
- Corticosteroid injections (typically methylprednisolone 40mg mixed with lidocaine) into the tendon sheath can provide significant relief for persistent cases.
- Physical therapy focusing on gentle stretching and strengthening exercises should be initiated after acute inflammation subsides.
- For cases resistant to conservative treatment for 3-6 months, surgical release of the tendon sheath may be necessary, as most patients with overuse tendinopathies fully recover within three to six months 1.
Diagnostic Approach
- MRI is the preferred diagnostic tool, as it can depict fluid-filled and synovial-lined structures, including ganglia, cysts, bursa, and tendon sheaths, and is useful for diagnosing infectious and noninfectious tenosynovitis in both the flexor and extensor wrist compartments 1.
- Ultrasonography can be used as an alternative initial examination, but MRI is generally preferred due to its higher sensitivity and specificity.
Prevention and Ergonomics
- Patients should modify activities that aggravate symptoms and consider ergonomic adjustments to prevent recurrence.
- Repetitive movements causing friction between the tendon and its sheath can lead to inflammation and thickening of the synovial lining, highlighting the importance of preventive measures.
From the Research
Extensor Compartment Tenosinovitis
- Extensor compartment tenosinovitis is a condition that affects the tendons in the extensor compartment of the wrist, leading to pain and swelling in the affected area 2.
- De Quervain's tenosynovitis is a specific type of extensor compartment tenosinovitis that affects the first dorsal compartment, which covers the abductor pollicis longus and extensor pollicis brevis tendons 3, 2.
- The condition is often caused by overuse or repetitive strain on the tendons, and can be treated with conservative measures such as anti-inflammatory medication, corticosteroid injections, and occupational therapy 3.
- In some cases, surgery may be necessary to release the affected tendon compartment and relieve symptoms 3, 2.
- A volar approach to the first extensor compartment has been described as a novel surgical technique that allows for direct visualization of the retinaculum and a midline retinacular release, with a decreased risk of iatrogenic nerve injury 2.
Treatment Options
- Conservative treatment options for extensor compartment tenosinovitis include anti-inflammatory medication, corticosteroid injections, and occupational therapy 3, 4.
- Corticosteroid injections have been shown to be effective in treating de Quervain's tenosynovitis, with success rates of up to 80% 4.
- Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat tendinopathy, but their effectiveness in treating extensor compartment tenosinovitis is not well established 5, 6.
- Surgery may be necessary in cases where conservative treatment fails to relieve symptoms, and can involve releasing the affected tendon compartment to relieve pressure on the tendons 3, 2.
Complications and Risks
- Complications of extensor compartment tenosinovitis can include persistent pain and swelling, as well as limited mobility and function in the affected wrist and hand 3, 4.
- Surgical treatment of extensor compartment tenosinovitis carries risks such as iatrogenic nerve injury, incomplete decompression, and tendon subluxation 2.
- The use of NSAIDs in treating extensor compartment tenosinovitis has been shown to have no significant effect on tendon-to-bone healing, but may impair the healing of certain musculoskeletal tissues 6.