Case

A 27yo has returned to work after maternity leave to their employment restocking an online shopping distribution warehouse. They present to the clinic with pain and swelling on the radial side of their left wrist. They have a lump approximately 1cm on the dorsal side of the left hand approximately mid-shaft on the digit 2 metacarpal that is non-painful to palpation. They indicate there has been no recent trauma and they have no history of trauma to that hand.

Question 2/3 - Which two tendons are involved with the lateral (radial) thumb/wrist pain in De Quervain's Tenosynovitis?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

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Incorrect. These are both flexors located on the anterior side, not the lateral. The flexor pollicis brevis is part of the thenar group of muscles on the thumb, while the flexor carpi radialis brevis is a flexor of the wrist.

Incorrect. These are both deep on the anterior side of the forearm and wrist, not the lateral side. Pronator quadratus functions for pronation while flexor digitorum profundus is for flexion of the fingers. Neither are involved in thumb movements.

Incorrect. These are both the deep muscles of the hand on the palmar side (PAD are the palmar interossei involved in adduction, while DAB would be the dorsal interossei involved in abduction). Lumbrical muscles are involved in the fine movements of the fingers.

There are no lumbrical muscles for the thumb. The thumb, insted, has the thenar muscle group for additional motor control.

Incorrect. These are both extensors of the wrist on the radial side. While present on the lateral side of the forearm and wrist, they are not directly involved in movement of the thumb. Since De Quervain's Tenosynovitis is an overuse strain on the thumb from lifting, these muscles have minimal involvement in the condition.

Incorrect. Opponens pollicis is deep on the palmar surface, part of the thenar group of thumb muscles. Adductor pollicis is present deep in the palmar side forming much of the flesh of the web space between the thumb and second digit. Thus, neither muscle is located on the lateral wrist where the pain is.

Incorrect. Extensor pollicis longus is present on the dorsal side (more medial on the thumb ,so not one of the lateral thumb tendons involved in the condition), and extensor digiti minimi involves the little finger, not the thumb. 

Correct! De Quervain's Tenosynovitis involves the most lateral tendons at the wrist, which are the abductor pollicis longus and extensor pollicis brevis.

The third 'outcropping' muscle is the extensor pollicis longus, the space between this tendon and the other two forms the anatomic snuffbox.