Stenosing tenosynovitis at the radial styloid process

　　1. Etiology

　　There is a narrow and shallow bone groove at the radial styloid process, with an uneven bottom surface covered by the transverse ligament of the wrist, forming a bony fibrous sheath tube, which constitutes the first interval of the dorsal wrist sheath. The tendons of the abductor pollicis longus and the extensor pollicis brevis pass through this sheath tube and then bend at a certain angle, respectively inserting into the first metacarpal bone and the proximal phalanx of the thumb. The sliding of the tendons produces a large amount of friction. When the thumb and the wrist move, this angle increases, thereby further increasing the friction between the tendons and the wall of the sheath tube. Over time, tenosynovitis may occur, causing the wall of the sheath tube to thicken, and the local tendons to become thickened, gradually producing stenotic symptoms. Especially the abductor pollicis longus, which participates in the opposition movement of the thumb, has more activity and plays a greater role in the onset of the disease. Because the tendons of women have a larger angle of flexion, the incidence is higher than that of men. In addition, sometimes there are wandering tendons in the sheath tube (mostly extensor tendons), and this anatomical variation can also produce symptoms of stenosing tenosynovitis.

　　2. Pathogenesis

　　In daily life and work, due to frequent activities, there is excessive friction between the tendons of the abductor pollicis longus and the extensor pollicis longus and the sheath, and the change in the direction of the tendons forming an angle further increases the mechanical friction between the tendons and the sheath. The secretory function of the synovial sheath in the elderly deteriorates, making it more likely to appear symptoms. The pathological changes are early congestion, edema, exudation, and other sterile inflammatory reactions. Repeated stimulation or prolonged disease duration may lead to chronic fibrous connective tissue proliferation, hypertrophy, and adhesion. The thickness of the sheath can increase from less than 1mm to 2-3mm, causing the sheath to become narrow, and the tendons to become deformed and deformed. Stenosing tenosynovitis may also be the consequence of certain quiescent or subclinical connective tissue diseases (such as rheumatism, rheumatoid arthritis). The proliferative stenotic sheath is like a tense belt pressing on the tendons, causing the adjacent tendons not under pressure to swell and bulge into a gourd-like shape. In severe cases, the tendons under pressure become adherent, proliferative, and thickened, forming a spindle-shaped shape with a large middle and normal ends. The clinical manifestations are pain, tenderness, and limited movement in the affected area. When the tendons pass through the narrow sheath, they may cause trigger-like locking, clicks, and jumps.

　　The main complications of this disease are pain, as well as joint mobility disorders, localized pain and swelling at the radial styloid process, limitation of extension of the thumb, pain during large amplitude extension and flexion movements of the thumb, which may radiate to the hand, elbow, shoulder, and other places. At the same time, joint clicks may also occur. Since this disease is not an infectious disease, the clinical complications are usually related to the disease itself, without complications in other tissues and organs.

　　1, General symptoms:This disease is common in housewives and manual workers, more common in middle-aged and elderly women, with a ratio of female to male of about 6:1, onset slowly, mainly manifested as: localized pain and swelling at the radial styloid process; limitation of extension of the thumb, pain occurs during the extensive flexion and extension activities of the thumb, which can radiate to the hand, elbow, shoulder, etc.

　　2, Local symptoms:During the examination, there is slight swelling at the radial styloid process, local tenderness is obvious, and sometimes a hard nodule can be felt locally, or there is a sense of friction and friction sound when the thumb is abducted, a few may have a pop, Finkelstein sign positive, that is, the thumb is adducted and flexed, the other four fingers are grasped by the thumb in the palm, at this time, when the wrist joint is deviated to the ulnar side, there is severe pain at the radial styloid process, which is positive. This is a characteristic sign of the disease. Based on the medical history, clinical symptoms, signs, and characteristic signs - Finkelstein sign positive, a diagnosis can be established.

　　1, When doing household chores such as washing clothes, cooking, knitting sweaters, cleaning, etc., attention should be paid to the correct posture of the fingers and wrists, do not overbend or overextend; do not carry heavy items; do not use excessive force with the fingers and wrists.

　　2, When you feel the joints of your body are tired, you can take a hot bath to relax the tense muscles, or apply heat to the sore areas.

　　3, In winter, it is best to use warm water to wash clothes, and after it snows, wear cotton gloves to prevent the hands from getting cold.

　　4, Rotate the wrist joint 360 degrees; or squeeze the palm into a fist and relax it several times; or press the fingers or palm back and forth several times, which can effectively relieve the pain in the hands.

　　For people who work at a desk for a long time, it is recommended to adopt the correct working posture, try to keep the hands balanced, and let the wrists touch the object, do not hang in the air.

　　According to the typical symptoms and signs of tenosynovitis, such as localized pain and swelling at the radial styloid process; limitation of extension of the thumb, pain occurs during the extensive flexion and extension activities of the thumb, which can radiate to the hand, elbow, shoulder, etc. During the examination, there is slight swelling at the radial styloid process, and local tenderness is obvious.

　　The diagnosis is relatively clear with the assistance of specific inciting experiments. Clinically, attention should be paid to the associated diseases, and corresponding imaging examinations should be performed to exclude local ligament, bone, and other tissue injuries, as well as various degenerative changes.

　　The dietary requirements for the narrow pulley tenosynovitis of the radius are very high, so the dietary adjustment for tenosynovitis is the most concerned issue for patients with tenosynovitis. Below, the editor summarizes some dietary注意事项 for tenosynovitis.

　　The diet for the narrow pulley tenosynovitis of the radius requires eating more vegetables, such as rapeseed, green vegetables, oranges, apples, green pears, hawthorn, celery, etc. It is recommended to eat more foods rich in protein and calcium, as well as lean meat, chicken, eggs, soy milk, etc. Fresh fruits and vegetables should be eaten in abundance. Attention should be paid to the intake of vegetables, such as rapeseed, green vegetables, and celery, to supplement plant protein; more foods rich in protein and calcium, and to supplement animal protein through the consumption of lean meat, chicken, eggs, etc.

　　Since the symptoms of radial styloid process stenosing tenosynovitis are most obvious when waking up in the morning, it is advisable to keep the arms close to the body and the wrist straight when going to bed at night. If the hands hang on the side of the bed, it will increase the pressure on the hands. Raise your hands: Avoid lowering your hands below your shoulders when you rest. Support your elbows on the table or lean your elbows on the back of a chair. Keep your hands up. This is a beneficial resting posture. Keep your arms close to your body and your wrist straight when sleeping. If the hands hang on the side of the bed, it will increase the pressure on the hands.

　　This is the introduction to the dietary adjustment of radial styloid process stenosing tenosynovitis, hoping that everyone can do a good job in the dietary care of tenosynovitis in their daily lives and lay a solid foundation for preventing recurrence.

　　I. Treatment

　　I. Non-surgical Treatment:Generally, non-surgical treatment is effective, such as reducing wrist activity, using wrist supports, applying blood circulation and swelling reduction drugs such as safflower oil, and applying ointment.

　　Method: Oral non-steroidal anti-inflammatory drugs (NSAID) and physical therapy, etc. Local anesthesia treatment can be performed when necessary, with 5ml of 1% lidocaine and 12.5mg of triamcinolone acetonide, injected into the tenon sheath under strict local skin disinfection, once a week, up to 3-4 times.

　　II. Surgical Treatment:For those who are ineffective after non-surgical treatment, a狭窄tenon sheath incision can be performed under local anesthesia. Pay attention to explore whether the extensor pollicis brevis tendon and the extensor pollicis longus tendon are wrapped in the same tenon sheath during the operation. If they are in two different tenon sheaths, both tenon sheaths must be incised. If there is a wandering muscle tendon, it must be removed. Lift the tendons, check for any abnormalities at the bottom of the tenon sheath, and if there are osteophytes, they need to be removed. Early practice of thumb movement is required after the operation. Pay attention not to damage the superficial branch of the radial nerve and the basilic vein that run locally during the operation.

　　II. Prognosis

　　Generally, the prognosis is good.