Stenosing Tenovaginitis affecting the Tendon o f Extensor Digiti Minimi at the Wrist G. Hooper and M. J. McMaster

STENOSING TENOVACANITIS AFFECTING THE TENDON OF EXTENSOR DIGITI MINIMI AT THE WRIST G. HOOPER and M. J. McMASTER, Edinburgh SUMMARY We report a patient with stenosing tenovaginitis affecting the sheath of the tendon of extensor digiti minimi. The similarities to typical de Quervain's disease are discussed.

CASE REPORT A fifty year old healthy right-handed legal book-keeper complained of pain and swelling on the dorsum of his right wrist just distal to the head of the ulna. The pain was made worse by gripping and sometimes he was unable to extend his little finger at the metacarpophalangeal joint. His work required that he write for several hours each day and he was scarcely able to do this because of pain. On examination there was a firm swelling just distal to the head of the ulna (Fig. 1). Attempting to flex the wrist after making a fist caused sharp discomfort in this area. Radiographs of the wrist were normal. A provisional diagnosis of stenosing tenovaginitis was made and because of the severity of his symptoms surgical exploration was performed. A longitudinal incision was made over the swelling, carefully avoiding dorsal branches of the ulnar nerve. The sheath of the fifth extensor compartment was found to be grossly thickened and the roof was excised, exposing the tendon of extensor digiti minimi which was found to divide into two tendons at this point (Fig. 2). The other extensor compartments were unaffected. Following operation the patient resumed full activities including writing and golf without recurrence of symptoms. Histologically the excised tissue consisted of mature fibrous tissue interspersed with small blood vessels and fraying of the inner surface of the sheath was evident. DISCUSSION Stenosing tenovaginitis of the first dorsal extensor compartment (de Quervain's disease) is common, but the other extensor compartments of the wrist are seldom affected by this condition. Burman (1953) reported two patients with stenosing tenovaginitis of the fifth dorsal compartment and found two other reports in the world literature. The onset of the condition had been preceded by a significant wrist injury in three of these patients. Drury (1960) stated that tenosynovitis of the fifth dorsal compartment was a complication of approximately 5~ of wrist injuries in adults. In contrast, the patient we report had no history of injury but the unusual amount of handwriting that he did each day may have been an aetiological factor. Variations in the anatomy of the first dorsal compartment and its contained tendons are common both in normal subjects and patients with de Quervain's disease (Lacey 1951), the most frequent finding being a duplication of the tendon of abductor pollicis longus. The anatomy of the tendon of extensor digiti minimi in the fifth dorsal compartment is also inconstant but a duplication of the tendoq was G. I-looper, M.M.Sc., F.R.C.S., Princess Margaret Rose Orthopaedic Hospital, Fairmilehead, EdinburghEHI0 7ED. The Hand-- Volume 11

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Stenosing Tenovaginitis affecting the Tendon o f Extensor Digiti Minimi at the Wrist G. Hooper and M. J. McMaster

Fig. I. Swelling on right wrist, just distal to the head of the ulna.

Fig. 2. Operative findings. Proximal is to the left. The thickened sheath has been opened. Note the terminal branch of the ulnar nerve passing obliquely across the sheath. 300

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Stenosing Tenovaginitis affecting the Tendon o f Extensor Digiti Minimi at the Wrist G. Hooper and M. J. McMaster

f o u n d in f o r t y - e i g h t o f the fifty-seven h a n d s d i s s e c t e d b y S c h e n k (1964). It is t h e r e f o r e u n l i k e l y t h a t the d u p l i c a t i o n o f the t e n d o n o f e x t e n s o r digiti m i n i m i f o u n d in o u r p a t i e n t p r e d i s p o s e d to stenosing t e n o v a g i n i t i s o f the fifth c o m p a r t m e n t . In its clinical p r e s e n t a t i o n s t e n o s i n g t e n o v a g i n i t i s a f f e c t i n g the fifth d o r s a l c o m p a r t m e n t is s i m i l a r to the m o r e f a m i l i a r de Q u e r v a i n ' s disease, as is t h e h i s t o l o g i c a l a p p e a r a n c e o f the t e n d o n s h e a t h ( M e a c h i m 1969). O n e o t h e r s i m i l a r i t y is w o r t h y o f n o t e : j u s t as i n a d v e r t e n t i n j u r y o f d o r s a l b r a n c h e s o f the r a d i a l n e r v e is a r e c o g n i s e d h a z a r d o f surgical t r e a t m e n t o f de Q u e r v a i n ' s disease, so the d o r s a l b r a n c h e s o f the u l n a r nerve a r e at risk in d e c o m p r e s s i o n o f the s h e a t h o f the e x t e n s o r digiti m i n i m i t e n d o n . REFERENCES BURMAN, M. (1952). Stenosing Tendovaginitis of the Dorsal and Volar Compartments of the Wrist. Archives of Surgery, 65: 752-762. DRURY, B. J. (1960). Traumatic Tendovaginitis of the Fifth Dorsal Compartment of the Wrist. Archives of Surgery, 80: 554-556. LACEY, T.. GOLDSTEIN, L.A, and TOBIN, C. E. (1951). Anatomical and Clinical Stndy of the Variations in the Insertions of the Abductor Pollicis Longus Tendon Associated with Stenosing Tendovaginitis. The Journal of Bone and Joint Surgery, 33A: 347-350. MEACHIM, G. and ROBERTS, C. (1969). The Histopathology of Stenosing Tendovaginitis. The Journal of Pathology, 98: 187-192. SCHENK, R.R. (1964). Variations of the Extensor Tendons of the Fingers. Surgical Significance. The Journal of Bone and Joint Surgery, 46A: 103-I 10.

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Stenosing tenovaginitis affecting the tendon of extensor digiti minimi at the wrist.

Stenosing Tenovaginitis affecting the Tendon o f Extensor Digiti Minimi at the Wrist G. Hooper and M. J. McMaster STENOSING TENOVACANITIS AFFECTING T...
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