Due to the complexity of the structures at the wrist diagnosis from physical examination can be challenging. In the majority of cases your symptoms will settle within normal healing times of 6-12 weeks. The other two most commonly injured are the sixth (extensor carpi ulnaris – Figure 2) and second (intersection syndrome) compartments. The first compartment is the most frequently affected site, called De Quervain’s disease. Any of the dorsal compartments of the wrist can develop tenosynovitis. Tenosynovitis is the inflammation of the fluid-filled tendon sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness.
The wrist is prone to injury, commonly due to trauma, repetitive strain injury and/or through inflammatory conditions, such as rheumatoid arthritis and can cause tenosynovitis.
These sheaths reduce the friction to the extensor tendons as they traverse the compartments that are formed by the attachments of the extensor retinaculum to the distal (far end) of the radius and ulna. As the tendons travel over the posterior (back) aspect of the wrist they are enclosed within synovial tendon sheaths. The extensor tendons are held in place by the extensor retinaculum. The extensor tendon compartments are anatomical tunnels on the dorsal wrist and these tendons allow you to predominantly extend (lift up your fingers). Commonly, the dorsal wrist has twelve tendons, divided into six compartments, with some compartments crossing over each other. An example, of the complexity of our anatomy can be demonstrated at the dorsal wrist (back of your hand). In completing a BSc Physiotherapy and MSc Diagnostic Musculoskeletal Ultrasound, Neil has always been fascinated by the human anatomy and learning ligaments, tendons, muscles etc. This time, Neil Liffen, director of East Coast Physio Ltd (ECP) discusses the wrist anatomy with particular emphasis on the back of the hand and common sites of tenosynovitis.
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