Anatomy:    

 

Two of the main tendons to the thumb pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. Tendons are rope-like structures that attach muscle to bone. The tendons are covered by a slippery thin soft-tissue layer called synovium. This layer allows the tendons to slide easily through a fibrous tunnel called a sheath.  The sheath involved is named the first dorsal extensor compartment.  It contains the abductor pollicus longus and extensor pollicus brevis tendons.

 

Any swelling of the tendons and/or thickening of the sheath, results in increased friction and pain with certain thumb and wrist movements.  

 

Who Gets It? 

• New mothers (& fathers) - lifting & carrying newborn; hormonal fluctuations associated with pregnancy.
• More common in patients with diabetes, rheumatoid arthritis and other inflammatory diseases.
• Repetitive gripping activities with wrist flexion and extension such as gardening.
• Common in middle-aged women.

What are the Symptoms? 

• Pain may be felt over the thumb side of the wrist. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
• A "catching" or "snapping" sensation may be felt when moving the thumb. 
• Pain and swelling may make it difficult to move the thumb and wrist.
• Swelling may be seen over the thumb side of the wrist. This swelling may accompany a fluid-filled cyst in this region.  

• Tenderness over thumb side of the wrist overlying the first dorsal extensor compartment. 
• Finkelstein's test:  pain on the thumb side of the wrist when the thumb is tucked into the palm and the wrist is bent towards the little finger.
• Pain with resisted thumb extension.

Non-Surgical Treatment: 

• Anti-inflammatory medication (NSAIDs) can be taken by mouth to help reduce the swelling and relieve pain.
• Splints can be used to rest the thumb and wrist.
• Hand therapy to improve motion and reduce pain.
• Corticosteroids can be injected into the tendon sheath to help reduce swelling and pain.

 

Surgical Treatment:  

• Surgery may be recommended if the symptoms are severe or do not resolve with non-surgical treatment. 
• The goal of the surgery is to open the fibrous sheath covering the tendons to make more room for the tendons to move and function.
• Surgery is performed on an outpatient basis.  It can be done under a general anesthetic or local anesthetic. 
• Patients are splinted for comfort following the procedure and usually require a 6-week recovery period. 

If you think you may have this condition and wish to be assessed, one of our hand surgeons (Dr. Roger Blauvelt and Dr. Donna Smith) would be happy to see you.  Please call Cascade Orthopaedics at 253-833-7750 to make an appointment.  We have offices in both Auburn and Bonney Lake for your convenience.