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Isolated tenosynovitis of the extensor carpi radialis brevis and longus tendons in the second dorsal compartment of the wrist

was confirmed on histological examination, which identified thickened collagen bundles with occasional groups of multinucleated giant cells. Deep to the fibrofatty tissue, the superficial surface of the pisiform bone was noted to be roughened, with the surface appearance of a plum stone (Figure 3). This could have provided an appropriate surface to set up an inflammatory reaction in the interposed tissues as a result of the shearing movements between the pisiform bone and table/desk surface on which a mouse was being moved repetitively. The thickened subcutaneous tissue was excised and the surface of the pisiform smoothed with a rongeur. In one case, the hypertrophic skin was excised and the defect reconstructed with a local skin flap. All three patients returned to work after 2 weeks and have remained pain free. In two cases, histological examination also identified multiple peripheral nerve bundles surrounded by thickened collagen bands in the subcutaneous tissues, suggestive of traumatic neuroma formation. The subcutaneous tissue in the third case included a single peripheral nerve bundle surrounded by fibrous tissue and thickened collagen bands. These nerve fibres are likely to be branches of the palmar cutaneous branch of the ulnar nerve. Repeated shearing of these subcutaneous nerve fibres against the rough surface of the pisiform bone probably accounted for the degree of pain experienced by these patients.