Stenosing tenovaginitis of extensor carpi ulnaris: brief report.

Abstract

Since 1895, when de Quervain first described stenosing tenovaginitis of the tendons of abductor pollicis longus and extensor pollicis brevis at the radial styloid, a number of similar lesions have been described around the wrist joint. The tendons involved include extensor digiti minimi (Drury 1955), extensor carpi ulnaris (Dickson and Luckey 1948), flexor carpi radialis (Fitton, Shea and Goldie 1968) and extensor indicis proprius (Ritter and Inglis 1969). The only published report on tenovaginitis of extensor carpi ulnaris indicates that this is rare and is usually precipitated by a twisting injury. We have collected 72 cases which demonstrate that the incidence of this condition is quite high; awareness of the possibility is clearly important. Patients and methods. Of our 72 patients treated over a five-year period 26 were men and 46 women. Seven patients had bilateral involvement, so a total of 79 wrists were treated. Patient’s ages ranged from 20 to 50 years, and they came from a wide range of occupations and social levels. They all presented with pain over the ulnar aspect of the wrist, aggravated by movement of the wrist and exertion. None gave a history of trauma or twisting injury and none had any associated disease. On examination, a firm fusiform swelling was present on the dorso-ulnar aspect of the wrist, usually extending from about 1 cm proximal to the ulnar styloid to the carpus (Fig. 1). There was no local warmth, but some tenderness over the swelling. Pain was elicited when the clenched fist was forced into radial deviation and when active ulnar deviation was attempted against resistance. Radiographs were normal in all cases. Treatment. All 72 patients had a trial of local infiltration with hydrocortisone acetate, but only nine patients obtained complete relief. The remaining 63 failed to respond, and had an operation some four to five weeks later. At operation, under either regional block or general anaesthesia, a lazy S longitudinal incision was made over the head and styloid process of the ulna, care being taken to protect the dorsal branch of the ulnar nerve. The thickened sheath of extensor carpi ulnaris was excised and the tendon freed completely. The wound was closed