Figure 1
Coronal 3D gradient T2 image. Thickening of the EPB and APL at the radial styloid with a loss of the soft tissue and subcutaneous fat planes.
De Quervain's tenosynovitis
SectionMusculoskeletal system
Case TypeClinical Cases
AuthorsKam Anthony, Hanson John
Connected authors
35 years, female
Clinical History
A 35-year-old female presented with pain over the radial styloid.
Imaging Findings
The patient presented with pain in the radial side of the wrist, which worsened with thumb movement. There was a swelling and point tenderness in the radial aspect of the wrist. The plain X-ray of
the wrist were found to be unremarkable. The patient underwent an MRI of the wrist for further assessment .
Discussion
De Quervain's tenosynovitis represents tenosynovitis and tendonitis of the first extensor compartment directly over the radial styloid. The condition is often diagnosed clinically and is found to be
associated with a characteristic radial styloid pain and a positive Finkelstein's test for thumb movement. Imaging including X-ray, ultrasound and MRI are often not required and are reserved for
difficult cases where differentiation from arthritis, fractures or osteonecrosis is needed. The larger abductor pollicis longus (APL) and smaller extensor pollicis brevis (EPB) tendons are affected,
as they pass through the fibro-osseous tunnel at the radial side of the anatomical snuff box. The condition is thought to arise from repetitive micro-traumas with increased friction and inflammation.
Imaging features show edema and fluid present at the first extensor compartment, often with a loss of tendon definition and enlargement. X-ray findings are rarely positive but help to exclude the
possibility of fractures being present. Ultrasonography is useful in showing characteristic changes of oedema and thickening of the synovial sheath. Flluid within the sheath is seen as
circumferential hypoechogenicity. Loss of the normal fibrillary tendon pattern on ultrasound indicates associated tendinosis. MRI scan shows tenosynovitis characterized by a hypo to intermediate T1
signal intensity within the tendon sheath distended with fluid. Often, there is a hypointense effacement of the subcutaneous fat superficial to the EPB and APL. Tendinosis of the EPB and the APL is
characterized by an intermediate signal on a proton density image with or without tendon enlargement. Tenosynovitis on T2 imaging is characterized by the presence of a fluid around the tendons.
Tendinosis on T2 imaging shows a medial or lateral convexity of the tendon, and an intermediate tendon signal, sometimes with a hyper-intense longitudinal tendon splitting.
Differential Diagnosis List
De Quervain's tenosynovitis.
Final Diagnosis
De Quervain's tenosynovitis.
References
[1]
Patel JC, Watson K, Joseph E, Garcia J, Wollstein R.
Long term complications of distal radius bone grafts.
J Hand Surg. 2003 Sep;28(5):784-8. (PMID: 14507508)
Case information
| URL: | https://www.eurorad.org/case/3103 |
| DOI: | 10.1594/EURORAD/CASE.3103 |
| ISSN: | 1563-4086 |
Figure 2
Sagittal proton density image showing thickening and increased signal of the tendons at the first extensor compartment.
Sagittal images showing thickening and increased signal of the tendons at the first extensor compartment.
Figure 3
Axiall fat sat proton density image. There is thickening and increased signal involving the EPB and APL with a loss of surrounding soft tissue planes.
Axial fat sat proton density image. There is thickening and increased signal involving the EPB and APL with loss of surrounding soft tissue planes.
Figure 4
An axial fat sat T2 weighted image
T2 weighted image showing fluid surrounding the thickened tendons.
Coronal 3D gradient T2 image. Thickening of the EPB and APL at the radial styloid with a loss of the soft tissue and subcutaneous fat planes.
Sagittal proton density image showing thickening and increased signal of the tendons at the first extensor compartment.
Sagittal images showing thickening and increased signal of the tendons at the first extensor compartment.
Axiall fat sat proton density image. There is thickening and increased signal involving the EPB and APL with a loss of surrounding soft tissue planes.
Axial fat sat proton density image. There is thickening and increased signal involving the EPB and APL with loss of surrounding soft tissue planes.
An axial fat sat T2 weighted image
T2 weighted image showing fluid surrounding the thickened tendons.