APL腱が主因と考えられたde Quervain病の3例

De Quervain's Disease Apparently Caused by Abductor Pollicis Longus Tenosynovitis. Reports of Three Cases

　de Quervain病は第1背側伸筋腱腱鞘区画の狭窄炎であり，本態は短母指伸筋腱（EPB腱）の腱鞘炎である．トリアムシノロン注射に抵抗し，手術中にEPB腱の異常を認めず，長母指外転筋（APL）腱に主病変を認めた3例を経験した．症例の年齢は，19歳，57歳，および70歳であった．1例には隔壁を認めたが，他の2例には隔壁を認めなかった．APL腱は2～3本あり，局所的肥厚，圧痕，あるいは停止異常などの変化を認めた．APL腱に主病変があるde Quervain病も存在するので注意を要する．

　De Quervain's disease is caused by tenosynovitis of the tendon sheath of the first dorsal compartment, and the main etiology is thought to be tenosynovitis of the extensor pollicis brevis (EPB) tendon. We report three cases in which abductor pollicis longus (APL) tenosynovitis was confirmed at surgery and no evidence of EPB tenosynovitis was found. The patients were a 19-year-old male, a 70-year-old female, and a 57-year-old female. A septum was present in one case and absent in 2 cases. There were two or three APL tendons, and examination of the APL tendons revealed local thickening, local stenosis secondary to compression, or anatomical variation in their insertion. APL tenosynovitis requires as much as attention EPB tenosynovitis in the treatment of de Quervain's disease.