RADIOGRAPHIC AND ULTRASONOGRAPHIC DIAGNOSIS OFSTENOSING TENOSYNOVITIS OF THE ABDUCTOR POLLICIS LONGUS MUSCLE IN DOGS KATHARINA M. HITTMAIR, VERONIKA GROESSL, ELISABETH MAYRHOFER 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 C 2012 Veterinary Radiology & Ultrasound. sheath. Key words: abductor pollicis longus muscle, dog, stenosing tenosynovitis, ultrasound. first metacarpal bone with an embedded sesamoid bone.7 The muscle is an abductor of the first digit, an adductor of the carpus, and stabilizes the carpus medially.8 In humans, chronic tendovaginitis of the abductor pollicis longus was first described in 1895.9 The clinical symptoms included swelling and pain over the radial styloid with reduced thumb motion caused by inflammation of the synovial sheath of the abductor pollicis longus and extensor pollicis brevis muscle. The condition is referred to as de Quervain’s disease or de Quervain’s tenosynovitis after the author of this first published account. Tenosynovitis of the abductor pollicis longus is a lesion with degeneration of the synovial layer of the tendon sheath in conjunction with thickening and fluid accumulation.10 Stenosing tendovaginitis occurs when ongoing friction causes fibrosis and mineralization of the tendon sheath, thereby causing pain and reduced function of the thumb.11, 12 Diagnostic imaging methods of de Quervain’s disease in people include radiographs of the carpus, showing a groove in the medial distal radius with sclerosis and small osteophytes in the soft tissue swelling.13 Scintigraphy and magnetic resonance imaging are also employed.13, 14 Ultrasonography is an efficient diagnostic tool for abductor pollicis longus tenosynovitis, as the fluid-filled tendon sheath Introduction C hronic front limb lameness in mid-sized to large-breed dogs with a firm swelling at the medial aspect of the antebrachiocarpal joint may be caused by stenosing tenosynovitis of the abductor pollicis longus muscle.1–6 Although the first digit of the front limb in dogs does not appear to serve a purpose, it is provided with a strong muscle and tendon. The abductor pollicis longus muscle originates on the lateral surface of the radius and ulna and the interosseous membrane. Its fibers blend into a strong tendon toward the carpus, crossing the tendon of the extensor carpi radialis muscle, and passing into the medial sulcus of the radius under the short medial collateral ligament. A tendon sheath of varying length is located in this segment. The tendon inserts medially on the proximal aspect of the From the Department of Companion Animals and Horses, Diagnostic Imaging Section, University of Veterinary Medicine, Veterin¨arplatz 1, 1210 Vienna, Austria (Hittmair, Groessl, and Mayrhofer). Presented in part at the Annual Conference of the European Association of Veterinary Diagnostic Imaging in Naples, Italy, October 5–8, 2005. Address correspondence and reprint requests to Katharina M. Hittmair, at the above address. E-mail: katharina.hittmair@vetmeduni. ac.at Received April 1, 2011; accepted for publication September 21, 2011. doi: 10.1111/j.1740-8261.2011.01886.x Vet Radio & Ultrasound, Vol. 53, No. 2, 2012, pp 135–141. 135 two Collies. Breeds included five Golden Retrievers.5 years (range 0. Diagram of the abductor pollicis longus tendon with transducer positions (arrows). The abductor pollicis longus tendon and tendon sheath were measured at all three examination points. Ultrasonographic evaluation of the abductor pollicis longus tendon was performed using either a 10–5 MHz or 15–7 MHz linear transducer. Briard. 4 Ultrasonography has been reported to be of little value as a diagnostic tool for abductor pollicis longus tenosynovitis in dogs. Survey radiographs were considered positive for abductor pollicis longus tenosynovitis when a distinct distal medial radial groove and/or osteophytes or enthesiphytes were visible along the medial distal aspect of the radius or carpus. two Labrador Retrievers. WA.1. German Shepherd.5–12. and at insertion on the first metacarpal bone (Fig. These ∗ Philips HDI 5000. 1). one service. Bothell. Munsterl¨ ander. and the remainder were working dogs including five hunting dogs. and one sled dog. and transducer position 3: insertion on the first metacarpal bone. carpus. and signs of an enthesopathy. Fourteen dogs were companion animals. Flexion and rotation of the carpus caused pain. 59 abductor pollicis longus tendons and tendon sheaths in 30 fresh cadaver large-breed dogs were examined ultrasonographically and measured. Materials and Methods Thirty dogs presenting from 2001 to 2010 with chronic front limb lameness. two Rottweilers. The dogs weighed between 25 and 43 kg with a mean of 33 kg. soft tissue swelling. two military dogs. presence of anechoic fluid in the tendon sheath. and painful carpal flexion were evaluated. seven were involved with agility training. The abductor pollicis longus tendon was examined in a sagittal plane at three standardized points: the distal radial groove. medial carpus. Pointer. and first metacarpal bone. Transducer position 1: at the distal radial groove.6 The purpose of the present study was to determine the value of ultrasonography in diagnosing tenosynovitis of the abductor pollicis longus in dogs and to characterize the ultrasonographic findings. 2012 FIG. and mediopalmar first digit was clipped. tendon thickening with changes in echogenicity. Ultrasonography was also performed on the contralateral abductor pollicis longus in unilaterally affected dogs with the same technique. 2. The tendon is black. The mean age of the dogs was 6. and osteophytes or enthesophytes along the medial distal radius. Radiographs were evaluated for soft tissue swelling medial and dorsal to the carpus. German Longhair Pointer. These dogs were then examined ultrasonographically.1–5 Histopathologic evaluation of these tendon sheaths reveal similar findings as in de Quervain’s disease with thickening and chondroid or osseous metaplasia. 1.15.136 HITTMAIR. and irregular mineralization located medial to the radial sulcus with varying mineralization. There were 15 male dogs. GROESSL. a firm swelling over the medial aspect of the carpus.2 years). one neutered male. Data collected included the contours of the distal radius and radial groove. transducer position 2: medial to the carpus. two American Staffordshire Terriers. Radiographs of the carpus in dogs with abductor pollicis longus tenosynovitis were characterized by a distinct distal radial sulcus. and one ¨ Samoyed.17 Stenosing tenosynovitis of the abductor pollicis longus has been reported in dogs2–4 and treatment has been evaluated. and Australian Shepherd each. . medial to the carpus.1 The dogs presented with chronic front limb lameness and a firm swelling medial to the distal radius. a distinct distal radial groove. Ten dogs had a history of a previous injury to one of the front limbs. English Bulldog. 16 The histopathologic appearance of the thickened abductor pollicis longus tendon sheath in people is characterized by accumulation of mucopolysaccharide and evidence of myxoid degeneration and chondroid metaplasia. AND MAYRHOFER and fibrosis are readily appreciated. and 13 neutered females.8 In a previous study.∗ The region around the distal medial radius. one female. surrounded by a light gray tendon sheath. thickness and calcification of the tendon sheath. The dogs were in lateral recumbency with the affected limb in a relaxed but extended position. eight mixed breeds. Mediolateral and dorsopalmar radiographs of both distal front limbs were acquired. English Setter. Comparative radiographs of the carpus. 2 STENOSING TENOSYNOVITIS ABDUCTOR POLLICIS LONGUS MUSCLE 137 TABLE 1. (A) Tubular bony proliferations (arrowheads) are present distal to the radial groove (arrows) surrounded by soft tissue swelling. grade 2: moderate thickening.0 mm. 5-year-old. grade 1: mild thickening.0 mm. agility training.0 mm. The sesamoid bone at the abductor pollicis longus insertion is visible (arrowhead). 2).5 mm. dorsopalmar view. ≥2. Bony proliferations and osteophytes either in or around the radial groove were seen in 31/37 carpi (84%). grade 2: moderate to severe thickening. (B) Left carpus. 53. ≥2. ≥3. The nonaffected contralateral carpi (n = 23) were radiographically normal. <2. These osteophytes were either singular in the groove or more extensive with irregular tubular proliferations extending beyond the styloid process (Fig. recognizable as osteophytes and periosteal reactions at the medial aspect of the proximal aspect of the first metacarpal bone. hunting dog. dorsopalmar (A) and mediolateral (B) view. Normal distal radius and carpus. (A) Right carpus.0 mm. NO. FIG. grade 3: severe thickening.0 to <3. Measurements were also compared to the nonaffected contralateral abductor pollicis longus tendon.5 mm. (B) Bony proliferations are seen on the craniodistal aspect of the radius (arrowheads) with soft tissue swelling. 10 (33%) had lesions of the right abductor pollicis longus and 13 dogs (43%) had changes on the left.0 mm for the tendon sheath. In the nonaffected . appearing more radiolucent with radiopaque contours (Fig. Ultrasonography of the carpal soft tissue swelling and the abductor pollicis longus allowed distinguishing between lesions of the tendon and tendon sheath.0 to <4. 8-year-old male Golden Retriever. Results A total of 37 carpi had lesions of the abductor pollicis longus. measurements were compared to previous data6 with a normal value of 1. In 35 of 37 radiographs of the distal radius (95%). grade 1: mild thickening.9 mm for the tendon and <2. FIG. Seven of 30 dogs (23%) had evidence of bilateral abductor pollicis longus tenosynovitis. 3. male Golden Retriever.0 mm. ≥2.VOL. 3). Radiographs of the left carpus. Soft tissue swelling is present medial to the carpus. Radiographic and Ultrasonographic Evaluation of Abductor Pollicis Longus Tenosynovitis (n = 37) Radiography Ultrasonography 35 31 37 6 36 (37)* 22 19 37 25 7 Deep radial sulcus Osteophytes distal radius Soft tissue swelling medial to carpus Tendinitis Fluid in tendon sheath Tendon sheath thickening Tendon sheath mineralization Enthesopathy ∗ Soft tissue swelling (ultrasonography) subdivided into lesions of the tendon and tendon sheath. the medial sulcus was deeper than the nonaffected limb. ≥4. Enthesopathies of the abductor pollicis longus were visible in 6 of 37 carpal radiographs (16%). dorsopalmar view. 2. The distal radial groove is radiolucent with radiopaque contours (arrows). A soft tissue swelling medial and dorsal to the distal radius and carpus was visible on all radiographs of affected limbs (37/37 = 100%). A 4-point system was used to evaluate tendon sheath thickening: grade 0: normal. These bone formations were presumed to be caused by ossification of the abductor pollicis longus tendon sheath. Radiographic and ultrasonographic findings are summarized in Table 1. Soft tissue swelling medial to the carpus and osteophytes along the radial groove were seen in all of these dogs. Abductor pollicis longus tendon thickening was graded by using a 3-point scale according to the following measurements: grade 0: normal.0 to <2. <2.2–1. the tendon was uniformly hyperechoic with a parallel fiber pattern (Fig. 5. The tendon is demarcated by a hyperechoic line.0 mm. 6. companion dog.0 mm ≥2. The tendon fiber pattern is irregular and more hypoechoic (arrows). the fluid was visible as a thin line. the peritendineum. agility training. The overall echogenicity of the tendon was slightly more hypoechoic. the tendon was thickened and had an irregular fiber pattern (Fig. which was scored as grade 0 or normal. Ultrasound image of abductor pollicis longus tenosynovitis with a fluid-filled tendon sheath. A similar tendon lesion was present at the insertion site of the abductor pollicis longus in 7 of 37 dogs (19%).9– 1. Ultrasonographic Scoring System of Adductor Pollicis Longus Tendon Thickening (n = 37) Grade 0 Grade 1 Grade 2 Tendon thickness Number of tendons <2.5 mm 15 15 7 FIG. The abductor pollicis longus tendon has irregular fibers and is hypoechoic (arrows) with no clear fiber pattern near its insertion on the first metacarpal bone (mc I) and a hypoechoic to anechoic area. sagittal view.0 to 3. male Golden Retriever. the tendon sheath is thickened (double-headed arrow). The contour of the proximal first metacarpal bone was irregular with some osteophytes (Fig. These tendons measured from 2. transducer position 2. The lesions were diagnosed as abductor pollicis longus tendinitis.138 HITTMAIR. 3. while others had extensive filling.2 mm (0. insertion site. 5-yearold.9 mm and were scored a grade 0. In 19 of 37 affected abductor pollicis longus tendons (51%). 5). medial to the carpal bones (c). with 15 tendons scoring grades 1 and 7 with a grade 2 (Table 2). In some instances.8 mm) and was a grade 0 or normal. transducer position 2. Ultrasound image of abductor pollicis longus tendinitis. sagittal view.8 mm). The surrounding tendon sheath is echogenic with a thin hypoechoic to anechoic layer (double-headed arrows). AND MAYRHOFER FIG. The remaining 15 of 37 ten- 2012 FIG. companion dog. A hypoechoic lesion is visible in the hyperechoic tendon (arrow) and there is no clear fiber pattern due to tendinitis. contralateral abductor pollicis longus tendons (n = 23). The mean tendon diameter was 1. . In 22 of the 37 affected abductor pollicis longus tendons (59%).3–1. 4. sagittal view. GROESSL. The tendon sheath was slightly echogenic with a thin hypoechoic to anechoic line (synovial layer) parallel to the abductor pollicis longus. These enthesopathies were characterized by irregular fibers of the abductor pollicis longus tendon with a hypoechoic area representing edema near the first metacarpal bone. transducer position 3. 8-year-old male Samoyed. medial to the carpus (c). transducer position 2. Ultrasound image of the normal abductor pollicis longus tendon of an 8-year-old male Golden Retriever. 4). The contours of the first metacarpal bone are irregular (arrowheads). Ultrasound image of abductor pollicis longus enthesopathy. The abductor pollicis longus tendon sheath had a mean thickness of 1.0 to <2. There is a large amount of anechoic fluid in the tendon sheath (f). 7). The parallel fiber pattern is uniformly hyperechoic. 6).6 mm with a range of 1. The peritendineum appeared as a hyperechoic line demarcating the tendon. the tendon sheath was distended and contained varying amounts of anechoic fluid surrounding the tendon (Fig. sled dog. The abductor pollicis longus tendon is clearly outlined. The fluid-filled TABLE 2.9year-old neutered female Collie. dons had a mean thickness of 1.6 mm (1.5 mm ≥2.3– 1. FIG. sagittal view. 7. 17 a grade 2.0 mm 0 12 17 8 Discussion FIG. stops. 8 . Ultrasound image of abductor pollicis longus tenosynovitis with a thickened tendon sheath. All 37 abductor pollicis longus tendons (100%) had a thickened tendon sheath (Fig. All dogs with abductor pollicis longus tenosynovitis were large-breed dogs.0 to <4. such as hunting. 8). medial to the carpal bones.20. mineralization and small calcifications were identified as hyperechoic foci in the distended tendon sheath with or without distal acoustic shadowing (Fig. the dominant hand is affected. Eight of the 30 dogs (27%) were mixed breeds and seven (23%) were Retrievers. tendon sheath was best visualized over the soft tissue swelling. transducer position 2. hormonal changes. The irregularly thickened tendon sheath has mixed echogenicity (double-headed arrows). or using a computer mouse or Blackberry. In agility training.7 The canine thumb is a vestigial digit with only minimal movement. 6-year-old male Rottweiler. and 7 of 30 dogs had bilateral tenosynovitis of the abductor pollicis longus. 8.14 This is thought to be due to the smaller diameter of the female hand. 5.4 In people. males were overrepresented. and repetitive housework. 14 stenosing tenosynovitis of the abductor pollicis longus in dogs was characterized by soft tissue swelling. bony proliferations along the abductor pollicis longus tendon sheath. The echogenicity of the wider tendon sheath ranged from hypoechoic to a medium echogenicity. Working dogs. 2 STENOSING TENOSYNOVITIS ABDUCTOR POLLICIS LONGUS MUSCLE 139 TABLE 3.1. 53. Twelve tendon sheaths scored a grade 1. Ultrasonographic Scoring System of Adductor Pollicis Longus Tendon Sheath Thickening (n = 37) Grade 0 Grade 1 Grade 2 Grade 3 Tendon thickness Number of tendon sheaths <2. Previous reports on abductor pollicis longus tenosynovitis include a German Shepherd. An irregularly thickened. playing a musical instrument. The thickness of the abductor pollicis longus tendon sheath varied along the tendon with an irregular inner surface. In previous reports on stenosing tenosynovitis of the abductor pollicis longus in dogs. The amount of exercise in the remaining 14 companion dogs was not noted.0 mm ≥4. NO. There are small hyperechoic foci in the tendon sheath (arrowheads). sagittal view. repetitive movements of the carpus are caused by quick turns. 9).VOL.7 mm.19 In most instances.1 Of the 30 dogs in this study.1–6. with 16 of 30 dogs being male. 9. seven were involved with agility training and nine were working dogs. a deep distal radial groove.18. and enthesopathies. de Quervain’s tenosynovitis may also be caused by excessive knitting. are also trained in this field. 21 The function of the abductor pollicis longus in dogs is abduction and extension of the first digit and medial stabilization of the carpus. Stenosing tenosynovitis or de Quervain’s disease in people is caused by repetitive movements of the wrist or overuse of the thumb. 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. de Quervain’s tenosynovitis is diagnosed commonly in women. and jumping over obstacles.0 mm ≥2. 6 We did not find this predominance. 9-year-old male American Staffordshire Terrier. military dog.3 and Collie. The cause of abductor pollicis longus tenosynovitis in dogs is repetitive motion or overuse of the carpal joint. 19 Besides work-related disorders affecting factory employees. Ultrasound image of abductor pollicis longus tenosynovitis with a thickened tendon sheath. rock climbing. hypoechoic tendon sheath is visible (double-headed arrows). companion dog. and 8 thickened tendon sheaths were a grade 3 (Table 3). FIG. These findings are consistent with those described in previous reports.5 Neither of these breeds was present in this study.0 mm ≥3. In a previous study Boxers and German Shepherds were overrepresented. In 25 of 37 thickened tendon sheaths (68%). sled. Measurements of the abductor pollicis longus tendon sheath ranged from 2.0 to <3. A side predilection was also not observed.13. transducer position 2. or military dogs.0 to 6.2 Golden Retriever. Fig. To evaluate the gliding motion of the abductor pollicis longus tendon in the tendon sheath.23 Although ultrasonography was previously deemed to be of limited value for abductor pollicis longus tenosynovitis. the tendon and its sheath were not identified. Small mineralizations within the tendon sheath wall. 3 Complete resection of the first digit was reported in one case.7 mm. This condition is therefore not an inflammatory disease. arthritis. and in 8 dogs the tendon sheath was severely thickened with measurements of up to 6. ultrasonography is used to assess changes in the size of the abductor pollicis longus and extensor pollicis brevis tendons and to identify a septum between the two tendons. but are divided by a septum in some patients. irregularities and new bone formation are seen at the radial tubercle above the styloid process. 1). 16 were lost to follow-up.15 The tendons are contained in the first extensor compartment of the wrist. Signs of myxoid degeneration are considered characteristic of de Quervain’s disease. acute abductor pollicis longus tenosynovitis is treated with local methylpredinosolone injections medial to the distal radius and carpus and the area is massaged.22 Other differential diagnoses for abductor pollicis longus tenosynovitis include trauma. 17 In few instances. In the study. were visualized ultrasonographically as small hyperechoic foci.2 While rupture or resection of the abductor pollicis longus tendon does not impair thumb function in people. These mineralizations or fibroses are caused by chronic inflammation and present with acoustic shadowing only when they exceed 2–3 mm. thickening of the abductor pollicis longus synovial sheath or all three.140 HITTMAIR. this treatment should be repeated. These enthesopathies were associated 2012 with tendon as well as tendon sheath thickening. none of the dogs showed lameness of the front limb found with abductor pollicis longus tenosynovitis. Mild thickening or a grade 1 was found in 12 dogs.1 It is unknown how much medial support the abductor pollicis longus tendon provides the carpus and whether osteoarthritis developed from other causes. Two underwent surgery with debridement of the abductor pollicis longus tendon sheath and resection of bony proliferations and were free of lameness 2 months later.1 After immobilization. and it has been postulated that the term stenosing tenosynovitis is a misnomer.22 With these injuries.1. a grade 2 or moderate thickening was found in 17 dogs.17 Abductor pollicis longus tenosynovitis in human patients is treated with intrasheath corticosteroid infiltration. tenosynovitis of the abductor pollicis longus was found in conjunction with tendon sheath thickening. ultrasonographically a disrupted fiber pattern and hypoechogenicity were more apparent. the first digit can be moved during the ultrasound examination. All dogs with front limb lameness had a firm swelling medial to the carpus. GROESSL. Additionally. surgical release of the tendons or compartment reconstruction is performed. but not in the synovial lining.24 When more extensive calcifications are present in the tendon sheath. which can lead to chondroid or osseous metaplasia of the tendon sheath in both people and dogs. Long-term follow-up examinations of dogs with resected abductor pollicis longus tendons are needed to prove the effects. surgical intervention is required with debridement of the tendon sheath or resection of osteophytes. 27 In dogs. no pain on flexion of the carpus. but rather by accumulation of mucopolysaccharide within the fibrous tendon sheath in both people and dogs. lymphocytes were found within the connective tissue. Of the 30 dogs in this study. Seven dogs had a grade 2 score with the widest abductor pollicis longus tendon at 3 mm. With the help of ultrasonography.1. AND MAYRHOFER Enthesopathies at the origin of the straight part of the short radial collateral ligaments should be considered as a differential diagnosis for stenosing abductor pollicis longus tenosynovitis. One dog was reexamined . these soft tissue swellings could be differentiated into those with fluid accumulation and those with thickening of the abductor pollicis longus tendon. 4. methylprednisolone injections and 3 weeks of joint immobilization. The range of abductor pollicis longus tendon measurements was minimal. the dogs were treated with shock wave therapy.28. 29 tenotomy in one dog leads to instability of the carpal joint and osteoarthritis. abductor pollicis longus tenosynovitis was not characterized by inflammation.1. 4 Tenotomy of the abductor pollicis longus tendon is also performed. This provides useful information for the surgical approach to release both tendon sheaths. not seen radiographically. In all dogs. The remaining 12 dogs were treated with oral nonsteroidal anti-inflammatory drugs.26. The best imaging position was medial to the carpus (transducer position 2). All dogs experienced reduction or disappearance of the firm swelling medial to the carpus. and lameness was not observed. In chronic disease. There was no clinical correlation between the ultrasonographic scoring system for the abductor pollicis longus tendon (Table 1) and tendon sheath (Table 2) and the degree of lameness in the dogs. and neoplasia. Enthesopathies at the insertion of the abductor pollicis longus tendon on the first metacarpal bone were visible ultrasonographically.5 mm above normal. Because of the ossifying tenosynovitis of the abductor pollicis longus near the distal radial groove (transducer position 1. In people. The soft tissue swelling medial to the distal radius and carpus seems to be due to abductor pollicis longus tendon sheath thickening.8 we found it to be useful. In previous histologic studies. Thickening of the abductor pollicis longus tendon (n = 22) was scored a grade 1 in 15 dogs with measurements within 0. visualization of the tendon sheath and tendon may be impaired.25 When this is ineffective. The tendon was distended with a hypoechoic area at the insertion and enthesiphytes appeared as hyperechoic foci. New York. In: Evans. Ultrasonographic examination of de Quervain’s disease. Mann D. 1st ed. Insertionstendopathien im Karpal.25:389–394. Matthewson MH. Rochat MC. Jacobsen JA.31:265–268. 3. Evans HE. Dawid N. Diwaker HN. 27. Grant JW. Focal radial styloid abnormality as a manifestation of de Quervain’s tenosynovitis. NO. 26. Gruber A. Freedman DM. Circ Organ Mov 1994. Fellner A. The dog and cat. Rofo 2008. d’Anjou MA. 2. 1 p. ¨ 6.VOL. Enthesiopathy with an abductor pollicis longus dysfunction in a Rough Collie dog.12:256–266. J Bone Joint Surg 1991. J Small Anim Pract 2005. Enthesiopathy of the short radial collateral ligaments in racing greyhounds. 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