Massage & Bodywork

November | December 2014

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F r e e m u s i c d o w n l o a d s f o r C e r t i f i e d m e m b e r s : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 95 The body compensates for the increased friction by enclosing the tendon in a synovial sheath. The sheath is in contact with the retinaculum, but the tendon slides back and forth inside the sheath and thereby reduces friction between the tendon and the binding retinaculum (Image 2). The tendon sheath greatly reduces stress on the tendons; however, they are not immune from pathology due to overuse. Chronic overuse can cause an infl ammatory reaction between the tendon and surrounding synovial sheath, causing fi brous adhesions to develop there as a result of the irritation. Having infl ammation and fi brous adhesions between the tendon and surrounding sheath is called tenosynovitis. There is a signifi cant distinction between tenosynovitis and tendinosis (often called tendinitis), which is the most common tendon pathology. Tendinosis is not an infl ammatory condition—it results from collagen degeneration within the tendon. Tenosynovitis, on the other hand, does have infl ammatory activity in the tissues, although it is frequently not apparent during physical examination. Alan reported pain in the wrist, near the base of the thumb. This is a location where two thumb tendons are highly susceptible to tenosynovitis; a condition called de Quervain's tenosynovitis. The profi le created by the two tendons when their muscles are contracted is sometimes referred to as the anatomical snuff box. These two thumb tendons, the abductor pollicis longus and extensor pollicis brevis, course beneath a binding retinaculum (Image 3). The extensor pollicis longus tendon is also in this region, but does not cause as many problems. Numerous occupational activities put stress on the thumb tendons underneath the retinaculum here. In fact, tenosynovitis in these thumb tendons is a common injury that plagues massage therapists, especially if they perform a large amount of thumb-pressure work, which many do. The exact cause of tenosynovitis is not always clear, but there does seem to be a strong correlation between overuse and the condition's development. Repeated friction is clearly a causative factor. A recent study unsurprisingly found a strong correlation between the onset of de Quervain's tenosynovitis and high-volume texting with the thumbs on a smartphone. 1 Some anatomical anomalies occur in this region, including a fi brous septum between the abductor pollicis longus and extensor pollicis brevis muscles. This fi brous division between the muscles may narrow the channel through which the tendons pass and increase friction leading to tenosynovitis. This septum is not palpable through physical examination and is only evident with high-tech diagnostic studies. Tendon surrounded by synovial sheath. This example is the long head of the biceps brachii. Image is from 3D4Medical's Essential Anatomy 3 application. 2 Biceps tendon sheath Extensor pollicis brevis Abductor pollicis longus Abductor pollicis longus and extensor pollicis brevis under the retinaculum at the wrist. Image is from 3D4Medical's Essential Anatomy 3 application. 3

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