Are grouped under the term tendinitis or tenosynovitis of the extensor or flexor in the wrist area, and De Quervain's tendonitis. There seems to be very few studies focused on the incidence or risk factors for these diseases in the workplace.
Tendonitis and tenosynovitis are observed during repeated movements and rapid flexions and extensions of the wrist whith weights, or slower flexions and extensions with heavy loads.
Tendonitis of the wrist-hand are favored by work activities including: welding, grinding, coring, meat, poultry, maids work ... They cause pain at flexion or extension against resistance of the wrist. Palpatory examination is also painful at pressure along the tendon path.
In the wrist area, ligaments hold the tendons in place. Either by holding the tendon sheath in place, either by forming compartments in which the tendons sneak. The first dorsal compartment of the wrist can be narrow, causing friction, inflammation and swelling of the tendons. Therefore, professional tasks that require repetitive and vigorous movements can lead to friction in the first dorsal compartment of the wrist. The existence of a correlation between hand-wrist tendinitis and exposure in the workplace is consistent with current knowledge about the mechanism of onset of the disease.
De Quervain's tendonitis is not simply an inflammation of the tendons but tendons and synovium.
It affects the tendon sheath that extends above the wrist to the thumb. The inflammation often begins during a change of activity, shock or unusual use. Tendons and their sheaths increase in volume in the pulley which is inextensible. Its most common causes are excessive torque wrist or other repetitive movements. Thus increasing friction and thus the inflammation is self-perpetuating.
This tendonitis affects most often women in their fifties. Frequent and repeated movements of the thumb, especially the thumb and index clamp as done by mechanics, physical therapists, assistants, are a predisposing cause of this tendonitis. In some cases, rheumatoid arthritis can be involved.
It is the inflammation of the tendons of extensor brevis and abductor pollicis longus of the thumb at an osteo-fibrous slide on the edge of the wrist.
The pathophysiology is a conflict between the content (tendons) and the container, with a thickening and stenosis of the osteo-fibrous slide that surrounds the adductor longus and extensor pollicis brevis. The other mechanism is that of a partially or totally split slide, or the existence of multiple tendons, 2 to 5 for the tendon of adductor longus tendons and 2 for the short stent.
This is basically a pain located at the outer edge of the wrist. This pain gradually appears in a few weeks and sometimes brutally. This tendonitis significantly hampers the movements of the thumb with radiating pain in the forearm which can become very intense and very disabling. There is frequently a swelling around the tendons at the outer edge of the wrist. Mobilization of the thumb towards the annular with a palmar flexion and ulnar deviation of the wrist puts tension in the tendons and wakes the pain : Finkelstein's test, pathognomonic of this tendonitis.
It results in pain with a snap feature or complete blockage of the finger extension or flexion.
There may be a bending stiffness of the intermediate joint (proximal interphalangeal joint), and tendons can also deteriorate to the point of requiring a specific repair.
The condition affects more the thumb, middle and ring fingers, but not only. A protrusion or thickening of the tendon sheath locks the finger in curved position.
This thickening is facilitated by repetitive movements, more rarely rheumatic diseases such as rheumatoid arthritis. Carpal tunnel syndrome can be considered as a contributing factor.
The flexor carpi ulnaris after passing in front of the ulnar styloid, is inserted on the upper part of the pisiform before splitting and attaching his new branches on the annular, hamate, 4th and 5th metacarpal ligaments.
At clinical examination :
I find an antero-internal pain at the edge of the wrist, with the presence of edema and especially pain on palpation of the radial edge. We find a pain in the stretching extension, abduction of the wrist and during isometric testing against manual resistance ; the movement of a violonist's left hand.
The flexor carpi radialis, which takes a tendon configuration in the lower third of the forearm, should systematically be considered for climbers facing pain in the anterolateral edge of the lower third of the forearm.
At clinical examination :
I find a palpatory pain, sometimes with swelling and pain in passive tension of the carpi radialis, and in forced extension of the wrist. This pain is re-induced during isometric contraction in flexion against resistance of the index and middle fingers. Biomechanically, the great palmar tilts the wrist to 30 °. In presence of a carpi radialis tendinitis, I search for an associated scapholunate trapeziometacarpal osteoarthritis.
It is a tenosynovitis with pain among the wrist's extension against resistance and pressure of the tendon. Pain sits at the base of the 2nd and 3rd metacarpals.
It usually touches degenerative tendons, after repetitive trauma or after a surgically treated wrist fracture. There is a significant risk of rupture, this is why the diagnosis and treatment must come early.
It's a pure insertion tendonitis of brachioradialis. The pain of brachioradialis tendinitis is mainly revealed by a painful palpation of the radial styloid. Unlike De Quervain's tenosynovitis pain is not triggered by the mobilization of the thumb or when Finkelstein maneuver.
February 17th, 2014