The extensor tendon compartments of the wrist are six tunnels that transmit the long extensor tendons from the forearm into the hand. Located on the posterior aspect of the wrist, each tunnel is lined internally by a synovial sheath and separated from one another by fibrous septa. In this article, we shall look at the anatomy of the extensor compartments of the wrist – their location, contents and clinical correlations.
The first extensor compartment is located on the lateral (radial) aspect of the wrist. It transmits two tendons: extensor pollicis brevis and abductor pollicis longus. These tendons form the lateral border of the anatomical snuffbox.
De Quervain's tenosynovitis is an inflammation of the tendons within the first extensor compartment of the wrist, resulting in wrist pain and swelling. This condition is most common in women between the ages of 30-50, especially those with occupations or hobbies involving repetitive movements of the wrist. Patients with De Quervain's tenosynovitis will often experience pain near the base of the thumb with an associated swelling (secondary to thickening of the tendon sheath). Movements involving grasping or pinching can be particularly painful and difficult.
Conservative management of De Quervain's tenosynovitis involves lifestyle advice to avoid any repetitive actions, as well as the use of a wrist splint. Steroid injections can also reduce swelling and relieve pain in most cases, and may be repeated several times if a good response is observed. For individuals who fail to respond to conservative management, surgical decompression of the extensor compartment can be performed under local or general anaesthetic.
The second extensor compartment contains the tendons of the extensor carpi radialis longus and extensor carpi radialis brevis. This compartment is separated from compartment 3 by Lister's tubercle – a bony prominence of the distal aspect of the radius.
Compartment three transmits the extensor pollicis longus tendon – this forms the medial border of the anatomical snuffbox.
The fourth extensor compartment of the wrist contains the tendons of the extensor digitorum and extensor indicis.
Compartment five transmits the extensor digiti minimi tendon, which travels into the little finger.
The sixth compartment is located on the medial (ulnar) aspect of the wrist. It contains the tendon of the extensor carpi ulnaris.
It is important to note that when one of the extensor compartments is irritated or inflamed, movements involving grasping or pinching can be particularly painful and difficult. In terms of treatment, conservative management involves lifestyle advice to avoid repetitive actions with the affected wrist, as well as the use of a wrist splint. Steroid injections can offer relief in most cases, and may be repeated if need be. In more extreme cases, surgical decompression of the extensor compartment may be performed under general or local anaesthetic.
The extensor tendon compartments of the wrist are six tunnels that transmit the long extensor tendons from the forearm to the hand. Situated on the posterior aspect of the wrist, these compartments are lined internally by a synovial sheath and separated from one another by fibrous septa. The first extensor compartment is located on the lateral (radial) aspect of the wrist, and contains two tendons: the extensor pollicis brevis and the abductor pollicis longus. The second compartment contains the tendons of the extensor carpi radialis longus and extensor carpi radialis brevis, and is separated from the third compartment by Lister's tubercle - a bony prominence on the distal aspect of the radius. Compartment three contains the extensor pollicis longus tendon, which forms the medial border of the anatomical snuffbox. Compartment four conducts the tendons of the extensor digitorum and extensor indicis, compartment five transmits the extensor digiti minimi tendon, and the sixth compartment, located on the medial ulnar side of the wrist, contains the tendon of the extensor carpi ulnaris.
De Quervain's tenosynovitis is an inflammation of the tendons within the first extensor compartment of the wrist, leading to wrist pain and swelling. Most commonly affecting women aged between 30-50, this condition is exacerbated by occupations or hobbies involving repetitive movements of the wrist. Treatment generally involves lifestyle advice to avoid repetitive actions and the use of a wrist splint. Steroid injections may also reduce swelling and relieve pain, and can be repeated several times if a good response is observed. For those not responding to conservative management, surgical decompression of the extensor compartment can be performed under local or general anaesthetic.
In conclusion, the extensor tendon compartments of the wrist are six tunnels that transmit the long extensor tendons from the forearm to the hand. They are located on the posterior aspect of the wrist, are separated by fibrous septa and lined internally by a synovial sheath. De Quervain's tenosynovitis is an inflammation of the tendons within the first extensor compartment of the wrist, leading to wrist pain and swelling. Treatment involves lifestyle advice, the use of a wrist splint, and steroid injections, with surgical decompression of the extensor compartment being used in more extreme cases that do not respond to conservative management.
