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RADIOGRAPHIC AND ULTRASONOGRAPHIC DIAGNOSIS OF
STENOSING TENOSYNOVITIS OF THE ABDUCTOR POLLICIS LONGUS
MUSCLE IN DOGS
Stenosing tenosynovitis of the abductor pollicis longus muscle causes chronic front limb lameness in dogs. The
lesion, similar to de Quervain’s tenosynovitis in people, is caused by repetitive movements of the carpus. Thirty
dogs with front limb lameness, painful carpal flexion, and a firm soft tissue swelling medial to the carpus
were examined prospectively. Seven dogs had bilateral abductor pollicis longus tenosynovitis. Radiographs of
the carpus were characterized by a deeper radiolucent medial radial sulcus and bony proliferations medial
and slightly cranial to the distal radius, resulting in stenosis of the tendon sheath and subsequent tendinitis.
Ultrasonographic examination of the firm soft tissue swelling medial to the carpus was characterized by an
irregular hypoechoic abductor pollicis longus tendon or tendinitis in 22 of 37 dogs. Nineteen of 37 abductor
pollicis longus tendon sheaths were fluid-filled and all tendon sheaths were thickened, more hyperechoic, with
small hyperechoic mineralizations embedded in the connective tissue of the abductor pollicis longus tendon
sheath in 25 dogs. Enthesopathy of the abductor pollicis longus tendon was identified in seven dogs. While
radiographs of stenosing tenosynovitis of the abductor pollicis longus are helpful in visualizing the deep radial
sulcus and osteophytes medial to the distal radius, ultrasonography is useful to distinguish between lesions of
the tendon or tendon sheath and to determine thickness and fluid content of the abductor pollicis longus tendon
sheath. C 2012 Veterinary Radiology & Ultrasound.
Key words: abductor pollicis longus muscle, dog, stenosing tenosynovitis, ultrasound.
135
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136 HITTMAIR, GROESSL, AND MAYRHOFER 2012
Radiography Ultrasonography
Deep radial sulcus 35 -
Osteophytes distal radius 31 36
Soft tissue swelling medial to carpus 37 (37)*
Tendinitis - 22
Fluid in tendon sheath - 19
Tendon sheath thickening - 37
Tendon sheath mineralization - 25
Enthesopathy 6 7
∗
Soft tissue swelling (ultrasonography) subdivided into lesions of the ten-
don and tendon sheath.
Results
A total of 37 carpi had lesions of the abductor pollicis
longus. Seven of 30 dogs (23%) had evidence of bilateral
abductor pollicis longus tenosynovitis, 10 (33%) had lesions
of the right abductor pollicis longus and 13 dogs (43%) had
changes on the left. Radiographic and ultrasonographic
findings are summarized in Table 1.
The nonaffected contralateral carpi (n = 23) were ra-
diographically normal. A soft tissue swelling medial and
dorsal to the distal radius and carpus was visible on all
radiographs of affected limbs (37/37 = 100%). In 35 of
37 radiographs of the distal radius (95%), the medial sul-
cus was deeper than the nonaffected limb, appearing more
radiolucent with radiopaque contours (Fig. 2). Bony pro- FIG. 3. Radiographs of the left carpus, 5-year-old, male Golden Retriever,
liferations and osteophytes either in or around the radial hunting dog; dorsopalmar (A) and mediolateral (B) view. (A) Tubular bony
proliferations (arrowheads) are present distal to the radial groove (arrows)
groove were seen in 31/37 carpi (84%). These osteophytes surrounded by soft tissue swelling. (B) Bony proliferations are seen on the
were either singular in the groove or more extensive with ir- craniodistal aspect of the radius (arrowheads) with soft tissue swelling.
regular tubular proliferations extending beyond the styloid
process (Fig. 3). These bone formations were presumed to
be caused by ossification of the abductor pollicis longus ten- Soft tissue swelling medial to the carpus and osteophytes
don sheath. Enthesopathies of the abductor pollicis longus along the radial groove were seen in all of these dogs.
were visible in 6 of 37 carpal radiographs (16%), recogniz- Ultrasonography of the carpal soft tissue swelling and the
able as osteophytes and periosteal reactions at the medial abductor pollicis longus allowed distinguishing between le-
aspect of the proximal aspect of the first metacarpal bone. sions of the tendon and tendon sheath. In the nonaffected
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138 HITTMAIR, GROESSL, AND MAYRHOFER 2012
Discussion
Stenosing tenosynovitis or de Quervain’s disease in peo-
ple is caused by repetitive movements of the wrist or overuse
of the thumb.18, 19 Besides work-related disorders affect-
ing factory employees, de Quervain’s tenosynovitis may
FIG. 8. Ultrasound image of abductor pollicis longus tenosynovitis with also be caused by excessive knitting, rock climbing, play-
a thickened tendon sheath, 9-year-old male American Staffordshire Terrier, ing a musical instrument, or using a computer mouse
companion dog; sagittal view, transducer position 2. An irregularly thick-
ened, hypoechoic tendon sheath is visible (double-headed arrows). or Blackberry.20, 21 The function of the abductor pollicis
longus in dogs is abduction and extension of the first digit
and medial stabilization of the carpus.7 The canine thumb
tendon sheath was best visualized over the soft tissue is a vestigial digit with only minimal movement. The cause
swelling, medial to the carpal bones. of abductor pollicis longus tenosynovitis in dogs is repeti-
All 37 abductor pollicis longus tendons (100%) had a tive motion or overuse of the carpal joint.1 Of the 30 dogs
thickened tendon sheath (Fig. 8). The thickness of the ab- in this study, seven were involved with agility training and
ductor pollicis longus tendon sheath varied along the ten- nine were working dogs. In agility training, repetitive move-
don with an irregular inner surface. The echogenicity of the ments of the carpus are caused by quick turns, stops, and
wider tendon sheath ranged from hypoechoic to a medium jumping over obstacles. Working dogs, such as hunting,
echogenicity. In 25 of 37 thickened tendon sheaths (68%), sled, or military dogs, are also trained in this field. The
mineralization and small calcifications were identified as amount of exercise in the remaining 14 companion dogs
hyperechoic foci in the distended tendon sheath with or was not noted.
without distal acoustic shadowing (Fig. 9). Measurements All dogs with abductor pollicis longus tenosynovitis were
of the abductor pollicis longus tendon sheath ranged from large-breed dogs. In a previous study Boxers and German
2.0 to 6.7 mm. Twelve tendon sheaths scored a grade 1, 17 Shepherds were overrepresented.5 Neither of these breeds
a grade 2, and 8 thickened tendon sheaths were a grade 3 was present in this study. Eight of the 30 dogs (27%) were
(Table 3). mixed breeds and seven (23%) were Retrievers. Previous
reports on abductor pollicis longus tenosynovitis include a
German Shepherd,2 Golden Retriever,3 and Collie.4
In people, de Quervain’s tenosynovitis is diagnosed com-
monly in women.14 This is thought to be due to the smaller
diameter of the female hand, hormonal changes, and repet-
itive housework.19 In most instances, the dominant hand
is affected. In previous reports on stenosing tenosynovi-
tis of the abductor pollicis longus in dogs, males were
overrepresented.1, 5, 6 We did not find this predominance,
with 16 of 30 dogs being male. A side predilection was also
not observed, and 7 of 30 dogs had bilateral tenosynovitis
of the abductor pollicis longus.
While radiographic changes of de Quervain’s disease in
people are limited to radiolucent areas in the distal radial
styloid with some soft tissue mineralization,13, 14 stenos-
ing tenosynovitis of the abductor pollicis longus in dogs
FIG. 9. Ultrasound image of abductor pollicis longus tenosynovitis with a was characterized by soft tissue swelling, a deep distal ra-
thickened tendon sheath, 6-year-old male Rottweiler, military dog, transducer dial groove, bony proliferations along the abductor pollicis
position 2. The irregularly thickened tendon sheath has mixed echogenic-
ity (double-headed arrows). There are small hyperechoic foci in the tendon longus tendon sheath, and enthesopathies. These findings
sheath (arrowheads). are consistent with those described in previous reports.1–6, 8
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140 HITTMAIR, GROESSL, AND MAYRHOFER 2012
Enthesopathies at the origin of the straight part of the with tendon as well as tendon sheath thickening. To evalu-
short radial collateral ligaments should be considered as a ate the gliding motion of the abductor pollicis longus ten-
differential diagnosis for stenosing abductor pollicis longus don in the tendon sheath, the first digit can be moved during
tenosynovitis.22 With these injuries, irregularities and new the ultrasound examination.
bone formation are seen at the radial tubercle above the In people, ultrasonography is used to assess changes in
styloid process. In the study, none of the dogs showed lame- the size of the abductor pollicis longus and extensor pollicis
ness of the front limb found with abductor pollicis longus brevis tendons and to identify a septum between the two
tenosynovitis.22 Other differential diagnoses for abductor tendons.15 The tendons are contained in the first extensor
pollicis longus tenosynovitis include trauma, arthritis, and compartment of the wrist, but are divided by a septum
neoplasia.23 in some patients. This provides useful information for the
Although ultrasonography was previously deemed to be surgical approach to release both tendon sheaths.
of limited value for abductor pollicis longus tenosynovitis,8 In previous histologic studies, abductor pollicis longus
we found it to be useful. All dogs with front limb lameness tenosynovitis was not characterized by inflammation, but
had a firm swelling medial to the carpus. With the help of rather by accumulation of mucopolysaccharide within the
ultrasonography, these soft tissue swellings could be differ- fibrous tendon sheath in both people and dogs.1, 4, 17 In few
entiated into those with fluid accumulation and those with instances, lymphocytes were found within the connective
thickening of the abductor pollicis longus tendon, thicken- tissue, but not in the synovial lining. Signs of myxoid de-
ing of the abductor pollicis longus synovial sheath or all generation are considered characteristic of de Quervain’s
three. Thickening of the abductor pollicis longus tendon disease, which can lead to chondroid or osseous metaplasia
(n = 22) was scored a grade 1 in 15 dogs with measure- of the tendon sheath in both people and dogs. This con-
ments within 0.5 mm above normal. Seven dogs had a grade dition is therefore not an inflammatory disease, and it has
2 score with the widest abductor pollicis longus tendon at been postulated that the term stenosing tenosynovitis is a
3 mm. The range of abductor pollicis longus tendon mea- misnomer.17
surements was minimal, ultrasonographically a disrupted Abductor pollicis longus tenosynovitis in human patients
fiber pattern and hypoechogenicity were more apparent. is treated with intrasheath corticosteroid infiltration.25
In all dogs, tenosynovitis of the abductor pollicis longus When this is ineffective, surgical release of the tendons
was found in conjunction with tendon sheath thickening. or compartment reconstruction is performed.26, 27 In dogs,
Mild thickening or a grade 1 was found in 12 dogs, a grade acute abductor pollicis longus tenosynovitis is treated with
2 or moderate thickening was found in 17 dogs, and in local methylpredinosolone injections medial to the distal
8 dogs the tendon sheath was severely thickened with mea- radius and carpus and the area is massaged.1 After immo-
surements of up to 6.7 mm. The soft tissue swelling medial bilization, this treatment should be repeated. In chronic dis-
to the distal radius and carpus seems to be due to abduc- ease, surgical intervention is required with debridement of
tor pollicis longus tendon sheath thickening. There was no the tendon sheath or resection of osteophytes.1, 4 Tenotomy
clinical correlation between the ultrasonographic scoring of the abductor pollicis longus tendon is also performed.1, 3
system for the abductor pollicis longus tendon (Table 1) Complete resection of the first digit was reported in one
and tendon sheath (Table 2) and the degree of lameness in case.2 While rupture or resection of the abductor pol-
the dogs. licis longus tendon does not impair thumb function in
Small mineralizations within the tendon sheath wall, not people,28, 29 tenotomy in one dog leads to instability of the
seen radiographically, were visualized ultrasonographically carpal joint and osteoarthritis.1 It is unknown how much
as small hyperechoic foci. These mineralizations or fibroses medial support the abductor pollicis longus tendon pro-
are caused by chronic inflammation and present with acous- vides the carpus and whether osteoarthritis developed from
tic shadowing only when they exceed 2–3 mm.24 When more other causes. Long-term follow-up examinations of dogs
extensive calcifications are present in the tendon sheath, with resected abductor pollicis longus tendons are needed
visualization of the tendon sheath and tendon may be im- to prove the effects. Of the 30 dogs in this study, 16 were lost
paired. Because of the ossifying tenosynovitis of the abduc- to follow-up. Two underwent surgery with debridement of
tor pollicis longus near the distal radial groove (transducer the abductor pollicis longus tendon sheath and resection
position 1, Fig. 1), the tendon and its sheath were not iden- of bony proliferations and were free of lameness 2 months
tified. The best imaging position was medial to the carpus later. The remaining 12 dogs were treated with oral non-
(transducer position 2). steroidal anti-inflammatory drugs, methylprednisolone in-
Enthesopathies at the insertion of the abductor pollicis jections and 3 weeks of joint immobilization. Additionally,
longus tendon on the first metacarpal bone were visible the dogs were treated with shock wave therapy. All dogs ex-
ultrasonographically. The tendon was distended with a hy- perienced reduction or disappearance of the firm swelling
poechoic area at the insertion and enthesiphytes appeared medial to the carpus, no pain on flexion of the carpus,
as hyperechoic foci. These enthesopathies were associated and lameness was not observed. One dog was reexamined
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VOL. 53, NO. 2 STENOSING TENOSYNOVITIS ABDUCTOR POLLICIS LONGUS MUSCLE 141
ultrasonographically 2 months after treatment and had a graphic findings include soft tissue swelling medial to the
grade 0 tendon thickness (1.4 mm) compared to a previous carpus, radiolucent distal radial groove, and bony prolifera-
grade 2 (3.3 mm). tions that form a tunnel around the abductor pollicis longus
In summary, stenosing tenosynovitis of the abductor tendon. Ultrasonography proved useful in determining the
pollicis longus in dogs is characterized by thickening and extent of the abductor pollicis longus lesion and scoring the
mineralization of the tendon sheath. Characteristic radio- grade of tendinitis and tenosynovitis.
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