Outline:
There is common sheath of long abductor tendon and short extensor tendon of thumb. Overstrain of wrist makes too much movement of long abductor tendon and short extensor tendon through the common sheath. After a long time, it may cause traumatic inflammation of the sheath, resulting in congestion, edema and hypertrophy of the fibrous canal, and stenosed lumen so that the tendons slip through the canal hard, hence, and the corresponding symptoms. If the disease protracts longer, the lumen will become more and narrower due to fibrosis and contracture of the sheath, then the symptoms will become obstinate.

Major points for diagnosis  
1. There is a history of repeated carpal strain.
 
2. Mostly the disease develops gradually, occasionally there is acute attack due to special strain. The Patient complains of pain in the carpal dorsum, which radiates to the finger and forearm, weakness in carrying things, especially incapability to tip water out of a thermos bottle.
 
3. There are prominence or eminence on the styloid process of radius of the sick side, and tenderness between the styloid process and the first metacarpal bone base. Some patients complain of slight local redness, swelling and heat. Finkeisten’s sign is positive.

Treatment  
Tendon-smoothing manipulation:
The operator holds up the sick hand with one hand, and kneads the painful region of radial side of wrist and around it upward-and-downward and to-and-fro with the other hand.Then, he presses the acupoints of Shousanli (LI 10), Yangxi (LI 5), and Hegu (LI 4), etc., and plucks the tendon 4 or 5 times. After that, fixing the forearm of sick limb with his left hand and holding up the sick hand with the right hand, under the slight pulling the operator slowly rotates, flexes and extends the sick hand. Finally, he holds the end knuckle of sick thumb between his thumb and index finger of right hand, then suddenly pulls it towards the distal end, which can produce a flicking sound, playing a role of relaxing tendons. Before the end of manipulation, another massage of the sick part is given. Perform the manipulation above every day or every other day.

Herbal therapy  
Internal treatment based on syndrome different iat ion  

(1) Syndrome of qi and blood stagnation  
Main symptoms and signs:
Serious pain in the radial side of the wrist with marked swelling, the pain radiating to the hand, weakness of the wrist and thumb, or ecchymoses on the tongue, stringy or thready-choppy pulse.

Therapeutic methods:
Promoting blood flow to remove the stasis, activating qi flow to stop pain.

Recipe and herbs:
Modified Huoxue Decoction. Specifically, Chaihu ( Radix Bupleuri )6 g, Honghua ( Flos Carthmi )6 g, Danggui (Radix Angelicae Sinensis)10 g, Chishaoyao ( Radix Paeniae Rubrae )10 g, Taoren ( Semen Persicae )10 g, Zhike ( Fructus Citri Aurantii )10 g, Zhechong (Eupolyphaga seu Steleophaga)10 g, Jixueteng ( Caulis Spatholobi )15 g, Xuejie (Resina Draconis)10 g, and Gancao ( Radix Glycyrrhizae)3g.

(2) Syndrome of collateral disharmony  
Main symptoms and signs:
Aching and vague pain in the radial side of the wrist, weakness of the sick wrist, pale tongue, thready or minute-choppy pulse.

Therapeutic methods:
Relaxing tendons and activating collaterals.
 
Recipe and herbs:
Modified Guizhi Decoction. Guizhi ( Ramulus Cinnamomi Cassiae )6 g, Zhike (Fructus Citri Aurantii )6 g, Honghua (Flos Carthmi)6 g, Duhuo (Radix Angelicae Pubescentis )10 g, Fangfeng ( Radix Ledebouriellae Divaricatae )10 g, Danggui ( Radix Angelicae Sinensis )10 g, Chishaoyao (Radix Paeniae Rubrae )10 g, Xiangfu ( Rhizoma Cyperi Rotundi)10 g, Chenpi (Pericarpium Citri Reticutatae)10 g, Shengdihuang (Radix Rehmanniae)15 g, Yanhusuo ( Rhizoma Corydalis )15g, Gancao (Radix Glycyrrhizae )3 g.

External therapy:
Dingtong Paste or Shangke Xiaoyan Paste is externally applied, or fumigation and bathing of the sick part with Haitongpi Decoction.

Fixation:     
A piece of plaster band and a plastic or paper splint are used to bandage and fix the wrist joint in radial side with the position of thumb stretched out for 3 or 4 weeks, relieving the symptoms through restricting activities. This is for the case with serious pain.

Hydro-acupuncture therapy:
One milliliter of 1% procaine plus 12.5 mg prednisolone is used for local injection. It is better to inject the liquid into the sheath.

Small needle-knife therapy:
A bone-needle-knife 1 mm in diameter and 6 cm in length is used to make its tip into a 2 or 3 mm slope blade. After routine disinfection and local skin anesthesia, insert the knife deep into the sheath, incise the sheath along the distribution of tendon, withdraw the knife, and bandage it with sterile gauze.