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Radial styloid tenosynovitis occurs when the tendons that move the thumb outward (away from the index finger) become inflamed and swollen (tenosynovitis), most commonly from the irritation caused by repetitive gripping and twisting motions.
Two commonly affected tendons are extensor pollicis brevis and abductor pollicis longus. These tendons pass over the end of the radius (radial styloid) at the wrist. Normally, they slide through a canal (extensor retinaculum) without difficulty. Motion of the thumb and wrist become painful and difficult when the tendons become thickened and do not slide smoothly. This process is sometimes labeled as trauma of repetitive use.
The cause of tenosynovitis is unknown (idiopathic), but can be associated with repetitive grip, grasp, and vibration with the thumb positioned against the fingers while the wrist is moved toward the palm (flexed) and toward the little finger side of the hand (ulnarly deviated), as may occur when lifting or twisting. The problem is similar to trigger finger.
Risk: Individuals who use repeated gripping and twisting motions of their hand and wrist, such as chefs or cooks, checkout clerks, and carpenters, seem to be more susceptible to this condition. The condition is not uncommon in mothers and day care workers (often in both hands) who repeatedly lift 6- to 12- month-old babies. Adults are most commonly affected with females being at considerably greater risk than males. Incidence and Prevalence: The two most common entrapment tendinitis conditions in the hand and wrist are trigger finger and radial styloid tenosynovitis; however, trigger finger occurs 20 times more often (Meals). |
Source: Medical Disability Advisor
| History: Individuals complain of pain at the base of the thumb with wrist or thumb motion. There may be a visible swelling or a lump on the thumb side of the wrist, and at times a catching or snapping sensation. Individuals may complain of inability to grip. Physical exam: The exam reveals pain along the thumb side of the wrist (tip of radial styloid) aggravated with motion. Pain is made worse with simultaneous flexion of both of the interphalangeal joints of the thumb and ulnar deviation of the wrist (Finkelstein test). Swelling or fullness may be felt over the tendon. Tests: No invasive tests are required and x-rays are usually normal. X-rays are useful, however, in ruling out arthritic changes in the thumb and wrist. |
Source: Medical Disability Advisor
| Modifying the aggravating activity, and using nonsteroidal anti-inflammatory drugs (NSAIDs) are only effective in very mild cases. Immobilization of the thumb with a protective splint or cast may be necessary to provide rest for the tendons, which decreases the inflammatory response. However, individuals frequently remove the splint because of the restriction it imposes, and there is some question about its benefits when used alone. Injection of corticosteroid and an anesthetic provides relief in more difficult cases. If conservative measures fail, surgery may be necessary to decrease pressure over the tendon (tenosynovectomy). There are few studies that prove the effectiveness of various treatment options, but steroid injection tends to offer the best relief outside of surgery, whereas rest with NSAIDs are more useful for individuals who refuse steroid injection therapy.
Physical and occupational therapy modalities to decrease inflammation and adaptive splints may be recommended. |
Source: Medical Disability Advisor
| Most individuals will recover with injections or rest. Pain may decrease quickly, while swelling is slower to resolve. Those who require surgery (tenosynovectomy) can expect recovery from symptoms. Permanent impairment after surgery is rare unless nerve injury occurs. |
Source: Medical Disability Advisor
| Note on research and authorship Common clinical practice for the conservative (nonoperative) management of radial styloid tenosynovitis begins with three goals. The first goal is to decrease pain and inflammation in a 3 week trial of continuous splinting in a thumb spica splint. The next goal addresses the cause of the inflammation (postural, biological, or both). The final goal is to restore mobility and strength to the wrist once the symptoms have calmed. Response to the nonoperative protocol is monitored to determine whether surgery might be considered (Aiello).
Although common clinical practice includes a continuous trial of splinting, the efficacy of splinting is lacking in the medical literature. There is a 62% satisfactory outcome reported with a combination of local injection and splinting (Harvey; Lee). Modalities such as heat and cold may be used to reduce the pain and control inflammation in this region of the wrist (Braddom).
The duration of therapy depends on the severity of the symptoms and the response to treatment. If the initial pain and swelling subside and motion becomes pain free, the rehabilitation process may warrant less direct observation and guidance of the therapist, being continued independently through a home exercise program. As pain subsides, stretching and strengthening exercises of specific wrist and elbow muscles are emphasized. If work tasks are suspected as contributing to the condition, an ergonomic assessment might be beneficial so as to reduce the risk factors associated with the symptoms (Aiello; Lee).
If the wrist joint requires surgical release, some restrictions may be placed on the progression of the range of motion and strengthening in certain movements. These restrictions vary according to the degree or type of surgery that was performed and will be guided by the treating physician (Harvey; Lee; Witt). |
| FREQUENCY OF REHABILITATION VISITS | | Nonsurgical | |
| Physical, Occupational or Hand Therapist | | Up to 12 visits within 6 weeks | | | | | | | | Surgical | |
| Physical, Occupational or Hand Therapist | | Up to 12 visits within 6 weeks | |
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| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor
| Previous injury that altered the anatomy of the wrist would make treatment more difficult. Corticosteroid injections may cause changes in skin color and cannot be repeated more than one or two times. |
Source: Medical Disability Advisor
| Work restrictions include modified use of affected thumb, restricted lifting, gripping and twisting during early stages of treatment. Individuals may need to wear protective splinting for aggravating activities. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of radial styloid tenosynovitis been confirmed?
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Does individual have an underlying condition that may impact recovery?
Regarding treatment:
- Do symptoms persist despite avoidance of aggravating motion?
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If conservative measures failed to provide symptom relief, is individual now a candidate for surgical intervention?
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Has individual been involved in a comprehensive rehabilitation program?
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Has individual and/or job requirements been evaluated by an occupational therapist?
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Are assistive devices warranted and available?
Regarding prognosis:
- Has adequate time passed to allow conservative measures to resolve symptoms?
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Has individual been involved in a comprehensive rehabilitation program?
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Is individual now a candidate for surgical intervention?
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Has protective splinting been provided?
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Would individual benefit from reassignment or vocational retraining?
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Source: Medical Disability Advisor
| Aiello, B. "Wrist and Hand Tendonitis." Hand Rehabilitation: A Practical Guide. Eds. Gaylord L. Clark, et al. 2nd ed. New York: Churchill Livingstone, Inc., 1998.Braddom, Randolph L. Physical Medicine and Rehabilitation. 2nd ed. Philadelphia: W.B. Saunders, 2000. Harvey, F. J., P. M. Harvey, and M. W. Horsley. "De Quervain's Disease: Surgical or Nonsurgical Treatment." Journal of Hand Surgery 15 1 (1990): 83-87. National Center for Biotechnology Information. National Library of Medicine. 16 Mar. 2009 <PMID: 2299173>. Lee, M. P., and S. Nasser-Sharif. "Surgeon's and Therapist's Management of Tendonopathies in the Hand and Wrist." Hunter - Mackin - Callahan Rehabilitation of the Hand and Upper Extremity. Eds. E. J. Mackin, et al. 5th ed. Philadelphia: Mosby, Inc., 2002. Meals, Roy A. "De Quervain Tenosynovitis." eMedicine. Eds. Michael S. Clarke, et al. 17 Feb. 2009. Medscape. 16 Mar. 2009 <http://emedicine.medscape.com/article/1243387-overview>. Witt, J., G. Pess, and R. H. Gelberman. "Treatment of de Quervain Tenosynovitis. A Prospective Study of the Results of Injection of Steroids and Immobilization in a Splint." Journal of Bone and Joint Surgery 73 2 (1991): 219-222. National Center for Biotechnology Information. National Library of Medicine. 16 Mar. 2009 <PMID: 1993717>. |
Source: Medical Disability Advisor