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Marth T, Grob NA, Jacobson JA, Zechmann N, Guggenberger R, Falkowski AL. Tendon Anatomy and Tendon Disorders of the Wrist. ROFO-FORTSCHR RONTG 2025. [PMID: 39933717 DOI: 10.1055/a-2499-5875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2025]
Abstract
Wrist pain is common and can be attributed to tendon pathologies.This review aims to give a structured review of tendon anatomy, discuss anatomical pitfalls, and provide an overview of typical tendon pathologies of the wrist based on the current literature.Typical tendon pathologies of the wrist include de Quervain tenosynovitis, proximal and distal intersection syndrome, extensor and flexor pollicis longus tendon ruptures, and extensor carpi ulnaris subsheath injury. Typical pitfalls are multiple bundles of the abductor pollicis longus tendon or the centrally increased signal of the extensor carpi ulnaris tendon.Both ultrasound and MRI are appropriate modalities for assessing the tendons of the wrist. Knowledge of normal anatomy, variants, pathologies, as well as appropriate imaging is crucial to determine the diagnosis. · Multiple tendon bundles of the abductor pollicis longus are a common anatomical feature and should not be mistaken for tendon splitting.. · An anatomical pitfall resembles the frequently found centrally increased signal of the extensor carpi ulnaris tendon caused by fibrovascular tissue.. · In order to visualize the diagnosis of a proximal intersection syndrome, the MR scan field needs to include the area approximately 4 to 8 cm proximal to Lister's tubercle.. · The tendons of the thumb, i.e., extensor and flexor pollicis longus, are most commonly torn after distal radial fracture (EPL) and osseous hardware fixation (FPL).. · Marth T, Grob NA, Jacobson JA et al. Tendon Anatomy and Tendon Disorders of the Wrist. Rofo 2025; DOI 10.1055/a-2499-5875.
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Affiliation(s)
- Thomas Marth
- Clinic for Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zürich, Switzerland
- Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Nadja A Grob
- Department for Plastic and Hand Surgery, Inselspital University Hospital Bern, Bern, Switzerland
| | | | - Nadja Zechmann
- Clinic for Hand and Plastic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Roman Guggenberger
- Clinic for Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Anna L Falkowski
- Clinic for Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
- University of Zurich, Zurich, Switzerland
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Bajaj S, Chhabra A, Taneja AK. 3D MRI of the Wrist: Anatomy and Clinical Applications With Comparison to 2D MRI. Semin Roentgenol 2024; 59:429-446. [PMID: 39490038 DOI: 10.1053/j.ro.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 11/05/2024]
Affiliation(s)
- Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Atul Kumar Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX.
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Naredo E, Murillo-González J, Mérida Velasco JR, Olivas Vergara O, Kalish RA, Gómez-Moreno C, García-Carpintero Blas E, Fuensalida-Novo G, Canoso JJ. Examining the Forearm Intersection through Palpation and Ultrasonography. Diagnostics (Basel) 2024; 14:116. [PMID: 38201426 PMCID: PMC10802148 DOI: 10.3390/diagnostics14010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/10/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Forearm intersection syndrome causes pain, swelling, and a rub at the dorsal distal forearm where the first extensor compartment muscles intersect with the second compartment tendons. Although primary care settings tend to treat mild cases, high-performance athletes may suffer from severe symptoms that require surgery. This proof-of-concept study aims to help detect the anatomical substrate of forearm intersection syndrome using palpation and ultrasonography when available. METHODS Five individuals were studied using independent palpation and ultrasonography to identify the first dorsal compartment muscles and the second dorsal compartment tendons. The distances between the dorsal (Lister's) tubercle of the radius and the ulnar and radial edges of the first dorsal compartment muscles were measured to determine the location and extent of the muscle-tendon intersection. The palpatory and ultrasonographic measurements were compared using descriptive statistics and the paired t-test. RESULTS The mean distances from the dorsal tubercle of the radius to the ulnar and radial borders of the first dorsal compartment muscles were 4.0 cm (SE 0.42) and 7.7 cm (SE 0.56), respectively, based on palpation. By ultrasonography, the corresponding distances were 3.5 cm (SD 1.05, SE 0.47) and 7.0 cm (SD 1.41, SE 0.63). Both methods showed a similar overlap length. However, ultrasonography revealed a shorter distance between the dorsal tubercle of the radius and the ulnar border of the first compartment than palpation (p = 0.0249). CONCLUSIONS Our findings indicate that a basic knowledge of anatomy should help health professionals diagnose forearm intersection syndrome through palpation and, if available, ultrasonography.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Diaz, IIS Fundación Jiménez Díaz, Autónoma University, 28049 Madrid, Spain; (E.N.); (O.O.V.)
| | - Jorge Murillo-González
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
| | - José Ramón Mérida Velasco
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Otto Olivas Vergara
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Diaz, IIS Fundación Jiménez Díaz, Autónoma University, 28049 Madrid, Spain; (E.N.); (O.O.V.)
| | - Robert A. Kalish
- Division of Rheumatology, Tufts University School of Medicine, Boston, MA 02111, USA; (R.A.K.); (J.J.C.)
| | - Cristina Gómez-Moreno
- Department of Nursing, Hospital Universitario Fundación Jiménez Díaz, 28049 Madrid, Spain; (C.G.-M.); (E.G.-C.B.); (G.F.-N.)
| | - Eva García-Carpintero Blas
- Department of Nursing, Hospital Universitario Fundación Jiménez Díaz, 28049 Madrid, Spain; (C.G.-M.); (E.G.-C.B.); (G.F.-N.)
| | - Gema Fuensalida-Novo
- Department of Nursing, Hospital Universitario Fundación Jiménez Díaz, 28049 Madrid, Spain; (C.G.-M.); (E.G.-C.B.); (G.F.-N.)
| | - Juan J. Canoso
- Division of Rheumatology, Tufts University School of Medicine, Boston, MA 02111, USA; (R.A.K.); (J.J.C.)
- Department of Medicine, Emeritus, ABC Medical Center, Mexico City 01120, Mexico
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Flores DV, Murray T, Jacobson JA. Diagnostic and Interventional US of the Wrist and Hand: Quadrant-based Approach. Radiographics 2023; 43:e230046. [PMID: 37498783 DOI: 10.1148/rg.230046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Diagnostic and interventional US of the wrist and hand can be challenging due to the small size and superficial location of structures and various disorders that need to be considered. A quadrant-based approach (volar, ulnar, dorsal, and radial) provides a rational method for performing a focused examination and joint positioning during both diagnostic imaging and intervention. Volar wrist disorders primarily involve the median nerve and the digital flexor system comprised of the flexor tendons and pulleys. The ulnar nerve and extensor carpi ulnaris tendon are chiefly responsible for ulnar-sided wrist pain. The differential diagnosis for dorsal-sided symptoms typically involves the extensor tendon compartments and includes distal intersection syndrome, extensor pollicis longus tear, and digital extensor apparatus injury. The soft-tissue ganglion is the most common abnormality in the dorsal wrist, typically associated with wrist ligaments or joint capsule. Radial-sided pain may be secondary to de Quervain tenosynovitis and must be differentiated from the more proximal intersection syndrome. US is an important tool for assessing the ulnar collateral ligament of the first metacarpophalangeal joint of the thumb and differentiating between displaced and nondisplaced tears, thereby influencing management. Despite the complexity of the anatomy and potential pathologic features within the wrist, a focused quadrant-based examination can permit the sonologist to focus on the structures of relevance. In conjunction with a systematic approach, this can aid in precise and efficient diagnostic scanning and intervention of the wrist and hand. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Timothy Murray
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Jon A Jacobson
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
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Bhattacharya AK, Awan OA, Fenerty S, Taqi I, Jonnalagadda P, Ling S, Ali S. Repetitive Strain Injuries of the Upper Extremity: Imaging of Tendon Pathology and Compressive Neuropathies. Curr Probl Diagn Radiol 2020; 50:512-522. [PMID: 32826098 DOI: 10.1067/j.cpradiol.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/22/2022]
Abstract
Repetitive strain injuries (RSIs) encompass a broad clinicopathologic spectrum which includes discrete patterns of tissue injury involving tendons, bursae and nerves although an element of subjective symptomatology may be contributory. Upper extremity RSIs include De Quervain's tenosynovitis, intersection syndromes, epicondylitis, ulnar, and median neuritis as well as other compressive neuropathies. It is estimated that RSIs cost the US economy over $60 billion annually and while detailed clinical examination remains the diagnostic mainstay, imaging can aid in diagnosis, guide management and reduce costs.
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Affiliation(s)
| | - Omer A Awan
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Sarah Fenerty
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Irfan Taqi
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | | | - Stephen Ling
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, PA
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Gromis JT, Moore JA, Van Kouwenberg E, Benitez CL. Wrist Extensor Tendon "Floating Fat" Sign: A Strong Indicator to Recognize Occult Fractures in the Distal Radius: A Case Report. JBJS Case Connect 2020; 10:e0247. [PMID: 32649105 DOI: 10.2106/jbjs.cc.19.00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 24-year-old woman presented with traumatic left wrist pain. X-rays were negative for fracture. Computed tomography (CT) showed hemorrhagic fatty effusions within the second and third wrist extensor tendon compartments (the "floating fat" sign) and a tiny cortical defect in the Lister's tubercle. Three weeks later, magnetic resonance imaging demonstrated a nondisplaced distal radius fracture with extensive marrow edema. CONCLUSION The floating fat sign within the extensor tendon compartments is a critical sign of a distal radius fracture, which can be occult on x-ray and CT.
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Affiliation(s)
- Jonathan T Gromis
- 1Department of Radiology, Mount Sinai West Hospital, New York, New York 2Department of Orthopaedic Surgery, Mount Sinai West Hospital, New York, New York
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7
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Llopis E, Restrepo R, Kassarjian A, Cerezal L. Overuse Injuries of the Wrist. Radiol Clin North Am 2019; 57:957-976. [DOI: 10.1016/j.rcl.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hoy G, Trease L, Braybon (Deceased) W. Intersection syndrome: an acute surgical disease in elite rowers. BMJ Open Sport Exerc Med 2019; 5:e000535. [PMID: 31258929 PMCID: PMC6563899 DOI: 10.1136/bmjsem-2019-000535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Intersection syndrome is a relatively common condition in elite rowers and continuing conjecture over its pathology and best management often includes prolonged withdrawal from training and changes to the technique that may affect rowing outcomes. METHODS We reviewed a case series in a national rowing squad and the effect on time loss produced by the condition. We reviewed the pathophysiology. We revisited the aggressive operative management put forward in the 1960s and applied it to modern rowing workload by reviewing a retrospective case series of six international rowers who had early surgical intervention. RESULTS Approximately 5% of the squad suffered intersection syndrome during a 3-year period. The effect on training time was between 20% and 40% of their training time in the period. Using our understanding of the pathology as a true tendinitis of the second wrist compartment caused by fascial compression from hypertrophied first compartment muscles, we advocated earlier surgery and almost immediate return to training, which occurred at a median of 7 days postsurgery. We had successful return in five of six rowers in an accelerated programme to minimise muscle wasting and technique modification caused by the condition, achieving career goals in a matter of weeks after surgical intervention. CONCLUSIONS We encourage early surgical management of intersection syndrome of the wrist to allow almost immediate return to training, and therefore interfere less with technique modification and time out of the water. This minimises career disruption in the elite rowing community.
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Affiliation(s)
- Gregory Hoy
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
| | - Larissa Trease
- Emergency Department, Calvary Hospital Canberra, Canberra, Australian Capital Territory, Australia
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Hongsmatip P, Smitaman E, Delgado G, Resnick DL. Flexor carpi radialis brevis: a rare accessory muscle presenting as an intersection syndrome of the wrist. Skeletal Radiol 2019; 48:457-460. [PMID: 30097668 DOI: 10.1007/s00256-018-3034-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 02/02/2023]
Abstract
The flexor carpi radialis brevis (FCRB) is a rare accessory muscle of the forearm and wrist. It is typically asymptomatic, but has been discovered either incidentally during cadaveric studies or at the time of surgery in patients with distal forearm injury. Rarely, the FCRB muscle is associated with pain. We report a patient with wrist pain related to intersection between the tendon of the FCRB muscle and the tendon of the flexor carpi radialis (FCR) muscle, with an associated longitudinal split tear of the FCR tendon, documented by magnetic resonance imaging (MRI). To our knowledge, this is only the second report in the English literature of this intersection syndrome.
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Affiliation(s)
- Patcharee Hongsmatip
- Queen Savang Vadhana Memorial Hospital, 290 Jermjomphol Road Sriracha, Chonburi, 20110, Thailand. .,Department of Radiology, University of California San Diego, 408 Dickinson Street, Mail code 8226, San Diego, CA, 92103, USA.
| | - Edward Smitaman
- Department of Radiology, University of California San Diego, 408 Dickinson Street, Mail code 8226, San Diego, CA, 92103, USA
| | - Gonzalo Delgado
- Clinica MEDS, Av Bernardo Larrain Cotapoz 12654 Lo Barnechea, 7701224, Santiago, Chile
| | - Donald L Resnick
- Department of Radiology, University of California San Diego, 408 Dickinson Street, Mail code 8226, San Diego, CA, 92103, USA
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Blood TD, Morrell NT, Weiss APC. Tenosynovitis of the Hand and Wrist: A Critical Analysis Review. JBJS Rev 2018; 4:01874474-201603000-00007. [PMID: 27500430 DOI: 10.2106/jbjs.rvw.o.00061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Trigger FingerTrigger finger is common in patients with diabetes.Corticosteroid injections are effective in about 60% to 92% of cases.Proximal interphalangeal joint contracture may occur in long-standing cases.The outcomes of open and percutaneous releases are similar; however, surgeons are split on preferences. Intersection SyndromeThe classic finding is crepitus with wrist motion at the distal one-third of the radial aspect of the forearm. Extensor Pollicis Longus (EPL) TenosynovitisCorticosteroid injections should be used with caution because of the potential for rupture.EPL tenosynovitis is very rare. de Quervain DisorderThis condition is common in postpartum women.A positive Finkelstein test is considered to be pathognomonic of de Quervain disorder, but care should be taken to differentiate this condition from thumb carpometacarpal arthritis.Corticosteroid injections are effective in about 80% of cases.Patients in whom corticosteroid injections fail to provide relief of symptoms frequently have a separate extensor pollicis brevis (EPB) compartment.The abductor pollicis longus (APL) tendon has multiple slips; care should be taken not to confuse one of these slips as the EPB.Traction on the APL pulls up the thumb metacarpal but not the thumb tip.Traction on the EPB extends the thumb metacarpophalangeal joint.Care should be taken to avoid injury to the sensory branch of the radial nerve. Fourth Compartment TenosynovitisThis uncommon condition is most often seen in patients with rheumatoid arthritis.The condition involves a large diffuse area, as opposed to the compact dorsal ganglion cyst.
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Affiliation(s)
- Travis D Blood
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island
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Gitto S, Draghi AG, Draghi F. Sonography of Non-neoplastic Disorders of the Hand and Wrist Tendons. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:51-68. [PMID: 28708327 DOI: 10.1002/jum.14313] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis.
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Affiliation(s)
- Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Anna Guja Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
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Li TY. Unique Sonographic Presentation of Distal Intersection Syndrome. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017. [DOI: 10.1177/8756479317721664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Distal intersection syndrome is the tenosynovitis of the second compartment and the third compartment, at their cross point, in the dorsal wrist. It is a rare disorder presenting with pain, swelling, and tenderness in Lister’s tubercle area of the wrist. One of the causes may be the pulley effect of Lister’s tubercle on the third compartment, where the resultant tenosynovitis can spread to the second compartment through their communication foramen. This case of distal intersection syndrome is induced by hyperflexion and abduction injury of the thumb, which may have caused tenosynovitis of the third compartment by overstretching over Lister’s tubercle. It is unique that in addition to the typical presentation of the syndrome with tenosynovitis of the second and third compartments, the fourth compartment also displayed tenosynovitis. This extra presentation may result from the possible communication between the third and fourth compartments.
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Affiliation(s)
- Tony Y. Li
- Department of Diagnostic Imaging, Albany Medical Clinic, Toronto, ON, Canada
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Abstract
OBJECTIVE This article reviews the normal anatomy of the extensor tendons of the wrist as well as the clinical presentation and MRI appearances of common tendon abnormalities, such as tears, tenosynovitis, intersection syndromes, and associated or predisposing osseous findings. Treatment options are also discussed. CONCLUSION We review the anatomy and normal MRI appearance of the clinically important dorsal extensor tendons of the wrist, in addition to the spectrum of abnormalities associated with these tendons.
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Balakatounis K, Angoules AG, Angoules NA, Panagiotopoulou K. Synthesis of evidence for the treatment of intersection syndrome. World J Orthop 2017; 8:619-623. [PMID: 28875127 PMCID: PMC5565493 DOI: 10.5312/wjo.v8.i8.619] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/17/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023] Open
Abstract
Intersection syndrome is a rare sports overuse injury occurring through friction at the intersection of the first and second compartment of the forearm. Differential diagnosis must be carefully made, especially from De Quervain tendonsynovitis. Clinical examination provides with the necessary information for diagnosis, still magnetic resonance imaging scans and ultrasonography may assist in diagnosis. Treatment consists mainly of rest, use of a thumb spica splint, analgetic and oral nonsteroidal anti-inflammatory drugs and after 2-3 wk progressive stretching and muscle strengthening. Should symptoms persist beyond this time, corticosteroid injections adjacent to the site of injury may be useful. In refractory cases, surgical intervention is warranted.
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15
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Mattox R, Battaglia PJ, Scali F, Ottolini K, Kettner NW. Distal intersection syndrome progressing to extensor pollicis longus tendon rupture: a case report with sonographic findings. J Ultrasound 2016; 20:237-241. [PMID: 28900524 DOI: 10.1007/s40477-016-0223-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022] Open
Abstract
The purpose of this case report is to describe the value of musculoskeletal ultrasound (US) in diagnosing both distal intersection syndrome (DIS) and rupture of the extensor pollicis longus (EPL) tendon in the same patient. A 38-year-old female presented for evaluation of a painful bump of unknown etiology on the dorsolateral aspect of her non-dominant wrist. US demonstrated tenosynovitis distal to Lister's tubercle of the EPL and extensor carpi radialis tendon sheaths, consistent with DIS. Immobilization therapy was employed, during which time the patient suffered rupture of the EPL tendon. Follow-up US examination confirmed this additional diagnosis. Characteristic US findings of DIS and EPL tendon rupture were observed. Surgical intervention was required and the patient recovered without complication. Although EPL rupture is relatively common in the literature, DIS is rare. This is the first known case of imaging-proven DIS progressing to EPL tendon rupture. This case underscores the value of US as a widely available, cost effective, and dynamic imaging modality for evaluation of wrist complaints.
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Affiliation(s)
- Ross Mattox
- Department of Radiology, Logan University, 1851 Schoettler Road, Chesterfield, MO 63017 USA
| | - Patrick J Battaglia
- Department of Radiology, Logan University, 1851 Schoettler Road, Chesterfield, MO 63017 USA
| | - Frank Scali
- Clinical Intern, AUC School of Medicine, Cupecoy, St. Maarten
| | | | - Norman W Kettner
- Department of Radiology, Logan University, 1851 Schoettler Road, Chesterfield, MO 63017 USA
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Plotkin B, Sampath SC, Sampath SC, Motamedi K. MR Imaging and US of the Wrist Tendons. Radiographics 2016; 36:1688-1700. [DOI: 10.1148/rg.2016160014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Chatterjee R, Vyas J. Diagnosis and management of intersection syndrome as a cause of overuse wrist pain. BMJ Case Rep 2016; 2016:bcr-2016-216988. [PMID: 27681354 DOI: 10.1136/bcr-2016-216988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Wrist pain due to repetitive motion or overuse is a common presentation in primary care. This case reports the rare condition of intersection syndrome as the cause of the wrist pain in an amateur tennis player. This is a non-infectious, inflammatory process that occurs where tendons in the first extensor compartment intersect the tendons in the second extensor compartment. Suitable history and examination provided the diagnosis, which was confirmed by MRI. Management consisted of early involvement of the multidisciplinary team, patient education, workplace and sporting adaptations, rest, analgesia, reduction of load, protection and immobilisation of the affected joint followed by a period of rehabilitation.
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Affiliation(s)
- Robin Chatterjee
- Sports & Exercise Medicine, Charing Cross Hospital, London, UK Sports & Exercise Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Jay Vyas
- General Practice, Schopwick Surgery Elstree, Elstree, Hertfordshire, UK
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Gitto S, Draghi F. Normal Sonographic Anatomy of the Wrist With Emphasis on Assessment of Tendons, Nerves, and Ligaments. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1081-1094. [PMID: 27036166 DOI: 10.7863/ultra.15.06105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/24/2015] [Indexed: 06/05/2023]
Abstract
Sonography allows for rapid, cost-effective, noninvasive, and dynamic evaluation of soft tissue structures, thus representing a valuable tool for ruling out musculoskeletal disorders of the wrist. Because of the complexity of the wrist joint, sonographic training and familiarity with normal and variant anatomy are needed to avoid misdiagnosis and improper treatment. The aim of this article is to enlighten readers about the structures representing normal findings or common variants during sonographic evaluations of the wrist. The main text reviews the pertinent gross anatomy and procedures that are recommended to assess the soft tissue structures of the wrist, with particular emphasis given to tendons, nerves, and ligaments. Detailed explanations of the scanning techniques and sonographic appearance of the wrist structures are provided in the figure legends.
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Affiliation(s)
- Salvatore Gitto
- Radiology Institute, Scientific Institute for Research, Hospitalization, and Health Care, Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.
| | - Ferdinando Draghi
- Radiology Institute, Scientific Institute for Research, Hospitalization, and Health Care, Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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Sato J, Ishii Y, Noguchi H. Clinical and ultrasound features in patients with intersection syndrome or de Quervain's disease. J Hand Surg Eur Vol 2016; 41:220-5. [PMID: 26546605 DOI: 10.1177/1753193415614267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 10/02/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We investigated the demographic characteristics of patients who were diagnosed with intersection syndrome and also investigated the dominance of the affected hand, duration of symptoms and any precipitating factor for pain of the wrist. These features were compared with patients who had de Quervain's disease. Ultrasonography was used to confirm the clinical diagnosis. Intersection syndrome occurred more frequently in men and in the dominant hand than de Quervain's disease when all the patients were compared and when peripartum women were excluded. It occurred at a younger age than de Quervain's disease only when the comparison excluded peripartum women. Patients with intersection syndrome presented with a much shorter duration of symptoms. These results were consistent with previous reports about occupational factors in intersection syndrome, and might be helpful in the understanding of epidemiological difference between the two conditions. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- J Sato
- Ishii Orthopaedic and Rehabilitation Clinic, Saitama, Japan
| | - Y Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, Saitama, Japan
| | - H Noguchi
- Ishii Orthopaedic and Rehabilitation Clinic, Saitama, Japan
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Olchowy C, Łasecki M, Zaleska-Dorobisz U. Wrist ultrasound examination - scanning technique and ultrasound anatomy. Part 1: Dorsal wrist. J Ultrason 2015; 15:172-88. [PMID: 26675810 PMCID: PMC4579750 DOI: 10.15557/jou.2015.0015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/09/2015] [Accepted: 01/29/2015] [Indexed: 11/26/2022] Open
Abstract
Ultrasound imaging of the musculoskeletal system is superior to other imaging methods in many aspects, such as multidimensional character of imaging, possibility of dynamic evaluation and precise assessment of soft tissues. Moreover, it is a safe and relatively inexpensive method, broadly available and well-tolerated by patients. A correctly conducted ultrasound examination of the wrist delivers detailed information concerning the condition of tendons, muscles, ligaments, nerves and vessels. However, the knowledge of anatomy is crucial to establish a correct ultrasound diagnosis, also in wrist assessment. An ultrasound examination of the wrist is one of the most common US examinations conducted in patients with rheumatological diseases. Ultrasonographic signs depend on the advancement of the disease. The examination is equally frequently conducted in patients with pain or swelling of the wrist due to non-rheumatological causes. The aim of this publication was to present ultrasound images and anatomic schemes corresponding to them. The correct scanning technique of the dorsal part of the wrist was discussed and some practical tips, thanks to which highly diagnostic images can be obtained, were presented. The following anatomical structures should be visualized in an ultrasound examination of the dorsal wrist: distal radio-ulnar joint, radiocarpal joint, midcarpal joint, carpometacarpal joints, dorsal radiocarpal ligament, compartments of extensor tendons, radial artery, cephalic vein, two small branches of the radial nerve: superficial and deep, as well as certain midcarpal ligaments, particularly the scapholunate ligament and lunotriquetral ligament. The paper was distinguished in 2014 as the “poster of the month” (poster number C-1896) during the poster session of the European Congress of Radiology in Vienna.
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Affiliation(s)
- Cyprian Olchowy
- Division of General and Pediatric Radiology, Department of Radiology, Medical University of Wroclaw, Poland
| | - Mateusz Łasecki
- Division of General and Pediatric Radiology, Department of Radiology, Medical University of Wroclaw, Poland
| | - Urszula Zaleska-Dorobisz
- Division of General and Pediatric Radiology, Department of Radiology, Medical University of Wroclaw, Poland
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Drew MK, Trease L, Caneiro JP, Hooper I, Ooi CC, Counsel P, Connell DA, Rice AA, Knight E, Hoy G, Lovell G. Normative MRI, ultrasound and muscle functional MRI findings in the forearms of asymptomatic elite rowers. J Sci Med Sport 2015; 19:103-8. [PMID: 25819703 DOI: 10.1016/j.jsams.2015.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/26/2015] [Accepted: 02/14/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Forearm injuries are common and debilitating to elite rowers. Chronic exertional compartment syndrome, intersection syndrome and proximal radial bone stress injuries have been documented in this population. This paper explores the imaging findings related to these conditions in asymptomatic elite rowers. DESIGN Observational study. METHODS 19 asymptomatic senior elite and under-23 rowers currently competing at National level or above underwent ultrasound (US), Magnetic Resonance Imaging (MRI) and muscle functional MRI evaluation of their forearms. A comprehensive evaluation sheet identifying characteristics of bone stress, intersection syndrome and chronic exertional compartment syndrome was utilised based on a literature search and review by senior clinicians working with this population. RESULTS Peritendinous fluid of Extensor Carpi Radialis Longus (n=10, 53%) or Extensor Carpi Radialis Brevis (n=6, 32%) was a common finding on US. MRI had a higher rate of identification than US. Extensor Digitorum (Coeff=-1.76, 95%CI -3.04 to -0.49), Flexor Carpi Radialis (Coeff=-2.86, 95%CI -5.35 to -0.38) and Flexor Carpi Ulnaris (Coeff=-3.31, 95%CI -5.30 to -1.32), Pronator Teres (Coeff=-3.94, 95%CI -6.89 to -0.99), and Supinator (Coeff=-168, 95%CI -3.28 to -0.02) showed statistically significant changes immediately post-exercise. Mild proximal radial marrow hyperintensity was present (n=15, 78.9%) with three participants (15.8%) also having mild periosteal oedema of the radius. CONCLUSIONS Imaging findings commonly seen in symptomatic populations are observed in elite, asymptomatic rowers. Care should be taken when diagnosing bone stress injuries, intersection syndrome and compartment syndrome on imaging findings alone. Data presented can be utilised as a normative dataset for future case studies.
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Affiliation(s)
- Michael K Drew
- Department of Physical Therapies, Australian Institute of Sport, Australia; Department of Physiotherapy, Faculty of Health, University of Canberra, Australia; Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Australia.
| | - Larissa Trease
- Department of Sports Medicine, Rowing Australia, Australia
| | - J P Caneiro
- Department of Physiotherapy, Curtin University, Australia
| | - Ivan Hooper
- Department of Physical Therapies, Australian Institute of Sport, Australia
| | - Chin-Chin Ooi
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore; Department of Diagnostic Radiology, Monash University, Australia
| | | | - David A Connell
- Imaging at Olympic Park, Australia; Department of Medicine, Nursing and Healthcare, Monash University, Australia
| | - Anthony A Rice
- Department of Physiology, Australian Institute of Sport, Australia
| | - Emma Knight
- Department of Performance Research, Australian Institute of Sport, Australia
| | | | - Gregory Lovell
- Department of Sports Medicine, Australian Institute of Sport, Australia
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Christiaanse E, Jager T, Lenchik L, Buls N, Van Hedent E, De Maeseneer M. Thickness of extensor tendons at the proximal intersection: sonographic measurements in asymptomatic volunteers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2099-2103. [PMID: 25425365 DOI: 10.7863/ultra.33.12.2099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES An important sign of proximal intersection syndrome is thickening of the tendons at the area where the first extensor compartment tendons cross over the second compartment. Normal values for the thickness of the tendons have not been reported. Our purpose was to measure the thickness of the tendons with sonography at the level of the intersection in healthy volunteers and assess differences between men and women, dominant and nondominant sides, and different tendons. METHODS Forty-one asymptomatic volunteers (25 women and 16 men) were examined by 2 radiologists experienced in musculoskeletal sonography. The thickness of the tendons in the first and second compartments was measured at their intersection at standardized proximal and distal levels. Descriptive statistics were obtained. Differences between men and women, dominant and nondominant sides, and different tendons were evaluated by a Student t test. RESULTS The 95% confidence intervals for measurements of superimposed tendon groups varied between 0.30 and 0.40 cm in women and between 0.36 and 0.48 cm in men. There were no statistically significant differences in comparisons of the different tendon groups (P > .05). There were statistically significant differences (P < .05) between tendon thickness in men and women except for the right extensor carpi radialis longus + abductor pollicis longus (proximal measurement) and extensor carpi radialis brevis + extensor pollicis brevis (distal measurement). On comparison of dominant and nondominant sides, there were no statistically significant differences. CONCLUSIONS Normal tendon thickness should be between 0.30 and 0.40 cm in women and 0.36 and 0.48 cm in men. A comparison between asymptomatic and symptomatic sides and proximal and distal measurements is recommended.
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Affiliation(s)
- Ernst Christiaanse
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.)
| | - Tjeerd Jager
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.)
| | - Leon Lenchik
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.)
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.)
| | - Eddy Van Hedent
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.)
| | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.).
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Lok RLK, Griffith JF, Ng AWH, Wong CWY. Imaging of radial wrist pain. Part II: pathology. Skeletal Radiol 2014; 43:725-43. [PMID: 24522772 DOI: 10.1007/s00256-014-1826-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/06/2014] [Accepted: 01/11/2014] [Indexed: 02/02/2023]
Abstract
Pain on the radial side of the wrist is a common clinical presentation. Such wrist pain may provide a diagnostic challenge for radiologists, in view of the small size of the anatomic structures, the occasional subtlety of the imaging findings, the diversity of potential etiologies, as well as the non-infrequent occurrence of incidental asymptomatic findings in this area. This review discusses the imaging findings in both the more common and less common causes of radial-sided wrist pain, concentrating particularly on the detection of early disease and less readily apparent abnormalities.
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Affiliation(s)
- Ryan Lee Ka Lok
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Shatin, Hong Kong,
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Dębek A, Czyrny Z, Nowicki P. Sonography of pathological changes in the hand. J Ultrason 2014; 14:74-88. [PMID: 26675521 PMCID: PMC4579729 DOI: 10.15557/jou.2014.0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/15/2013] [Accepted: 07/29/2013] [Indexed: 11/22/2022] Open
Abstract
Everyday medical practice shows that most common problems within the hand result from overload, injuries and degeneration. Dorsal side pathologies such as de Quervain's and Wartenberg's disease, intersection syndrome or degenerative lesions of carpometa-carpal joint of the thumb discussed in the paper can be accurately diagnosed and differentiated by means of ultrasound examination. Ultrasound is similarly powerful in detection and grading of traumatic lesions involving extensor tendons and their sagittal bands or the flexor tendons and their pulleys. In the case of carpal tunnel syndrome one can not only visualize the median nerve but also other structures of the tunnel that may cause compression. Similarly ulnar nerve compression within the Guyon's canal can be well evaluated. In cases of nerve trauma one can precisely define the level, and in cases of nerve discontinuity, the distance between stumps can be measured which is important in surgery planning. Often nerve trauma is a sequelae of tendon reconstruction. In such cases scars and nerve entrapment can be depicted. Tumors within a hand are usually benign, of which the most common are ganglia. On ultrasound examination a connection between a ganglion and its source (usually a joint or sheath) can frequently be defined. The relationship of tumors to nerves, tendon sheaths or vessels may suggest their nature. Ultrasound with dynamic tissue assessment is a very valuable adjunct to clinical examination.
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Affiliation(s)
- Anna Dębek
- Indywidualna Specjalistyczna Praktyka Lekarska, Warszawa, Polska
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25
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Draghi F, Bortolotto C. Intersection syndrome: ultrasound imaging. Skeletal Radiol 2014; 43:283-7. [PMID: 24337446 DOI: 10.1007/s00256-013-1786-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/27/2013] [Accepted: 11/18/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the use of ultrasound for the diagnosis of intersection syndrome. MATERIALS AND METHODS A total of 1,131 reports from hand and wrist ultrasound examinations performed between 1 January 2008 and 31 December 2012 were re-evaluated. Two hundred and fifteen video clips present in the electronic database were reviewed by two musculoskeletal radiologists with 20 years of experience. RESULTS Of the 215 video clips reviewed, 21 patients were diagnosed with intersection syndrome. The mean age was 45 years (ranging from 22 to 60); 15 were male (13 with proximal intersection syndrome, 2 with distal intersection syndrome) and 6 female (5 with proximal intersection syndrome, 1 with distal intersection syndrome). CONCLUSION Intersection syndrome was identified in 1.9 % of all patients evaluated in the setting of a specialized hospital. Ultrasound is a non-invasive, simple, and economical method for the identification of intersection syndrome, tendon sheath anatomy (individual or separate sheaths) and to exclude other pathological conditions.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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26
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McConnell M, Cohen H, Scuderi M. Non-displaced distal radius fracture with fat-fluid levels in the adjacent extensor tendon sheaths on MRI. Skeletal Radiol 2013; 42:1761-5. [PMID: 23838843 DOI: 10.1007/s00256-013-1685-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 02/02/2023]
Abstract
We report a rare case of fat-fluid levels in the extensor tendon sheaths of the wrist on MRI. An 18-year-old female sustained a direct injury to her left hand while playing soccer. Plain radiographs showed soft tissue swelling with no definite fracture plane appreciated on the initial review of the images. The pain and swelling were severe and an MRI was obtained to evaluate for fracture and soft tissue injury. The MRI demonstrated a cortical defect near Lister's tubercle and multiple fat-fluid levels within the extensor tendon sheaths. This is the first reported case of fat-fluid levels within the extensor tendon sheaths on MRI, with only one previous case report of this entity on CT.
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Affiliation(s)
- Michael McConnell
- Department of Radiology, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA,
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27
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Machado BB, Lima CMADO, Junqueira FP, Coutinho Junior AC. Ressonância magnética na síndrome da interseção do antebraço: ensaio iconográfico. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000200017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A ressonância magnética tem papel importante na avaliação de pacientes com dor na face dorsal do antebraço distal e do punho. Entre as causas de dor destaca-se a síndrome da interseção, um processo inflamatório dos tendões do segundo compartimento extensor do antebraço (extensor radial curto do carpo e extensor radial longo do carpo), geralmente provocado por trauma local direto ou atividades repetitivas que exigem a flexão e extensão do punho. Nosso trabalho visa a ilustrar os achados típicos da síndrome da interseção do antebraço e discutir os principais diagnósticos diferenciais.
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Shiraj S, Winalski CS, Delzell P, Sundaram M. Radiologic case study. Intersection syndrome of the wrist. Orthopedics 2013; 36:165, 225-7. [PMID: 23464931 DOI: 10.3928/01477447-20130222-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sahar Shiraj
- Imaging Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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29
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Vargas A, Chiapas-Gasca K, Hernández-Díaz C, Canoso JJ, Saavedra MÁ, Navarro-Zarza JE, Villaseñor-Ovies P, Kalish RA. Clinical Anatomy of the Hand. ACTA ACUST UNITED AC 2012; 8 Suppl 2:25-32. [DOI: 10.1016/j.reuma.2012.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/24/2012] [Indexed: 01/14/2023]
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30
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Wysocki RW, Biswas D, Bayne CO. Injection Therapy in the Management of Musculoskeletal Injuries: Hand and Wrist. OPER TECHN SPORT MED 2012. [DOI: 10.1053/j.otsm.2012.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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31
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Ultrasound findings in intersection syndrome. J Med Ultrason (2001) 2012; 39:217-20. [DOI: 10.1007/s10396-012-0370-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/12/2012] [Indexed: 01/14/2023]
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Fantino O, Borne J, Bordet B. Conflicts, snapping and instability of the tendons. Pictorial essay. J Ultrasound 2012; 15:42-9. [PMID: 23396604 DOI: 10.1016/j.jus.2012.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Conflicts, snapping and instability of the tendons are common, and ultrasound (US) is the method of choice for evidencing these conditions thanks to the possibility to perform dynamic maneuvers during imaging studies. A conflict can occur between a tendon and a bone structure, other tendons, the retinacula or pulleys. Snapping can occur due to instability caused by rupture of the retinaculum, conflict between a thickened retinaculum and a bone prominence or due to an abnormal position of the tendon. Instability can occur due to insufficient ability of the retinaculum to keep the tendons in the bone groove or its failure to hold the tendons applied to the bone.The technique for evidencing conflicts, snapping and instability of the tendons is very demanding because it requires a thorough knowledge of the US appearance and dynamic maneuvers. However, at the present time US examination completed with dynamic maneuvers is the investigation of choice for evidencing these disorders and providing the clinicians with the necessary information.
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Affiliation(s)
- Olivier Fantino
- Medical Imaging du Parc, Orthopedic Clinic du Parc, Lyon, France
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33
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Soubeyrand M, Begin M, Pierrart J, Gagey O, Dumontier C, Guerini H. L’échographie pour le chirurgien de la main (conférence d’enseignement XLVe congrès de la Société française de chirurgie de la main). ACTA ACUST UNITED AC 2011; 30:368-84. [DOI: 10.1016/j.main.2011.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 08/30/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022]
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Abstract
STUDY DESIGN Case series. BACKGROUND Intersection syndrome is an overuse injury of the forearm. Taping has been described for the management of soft tissue injuries, yet there has been no report for the management of intersection syndrome using this method. The purpose of this case series was, therefore, to describe the efficacy of taping for the management of intersection syndrome. CASE DESCRIPTION Five patients with intersection syndrome were managed by taping, in an effort to reduce crepitus induced by thumb movements. Nonstretch sports tape was applied, with an ulnarly directed tension force across the dorsal aspect of the forearm. Taping was performed daily for 3 weeks. Follow-up took place at 1, 2, 3, and 4 weeks, and at 1 year from the initial consultation. OUTCOMES All patients demonstrated complete elimination of crepitus with the application of tape. Crepitus induced by wrist movements, tenderness over the dorsal forearm, and swelling were no longer present at 3-week follow-up. Disability identified by the disability/symptom subscale of the Disabilities of the Arm, Shoulder and Hand questionnaire decreased at 3-week follow-up, and this reduction was maintained at 4-week and 1-year follow-ups. DISCUSSION Taping improved symptoms and function in this small case series. One possible explanation for this improvement may be the alteration of soft tissue alignment. LEVEL OF EVIDENCE Therapy, level 4.
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Montechiarello S, Miozzi F, D'Ambrosio I, Giovagnorio F. The intersection syndrome: Ultrasound findings and their diagnostic value. J Ultrasound 2010; 13:70-3. [PMID: 23396515 DOI: 10.1016/j.jus.2010.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The intersection syndrome is a well-known overuse syndrome of the distal forearm. It is characterized by noninfectious, inflammatory changes involving the area of intersection of the first (abductor pollicis longus and extensor pollicis brevis) and second (extensor carpi radialis longus and extensor carpi radialis brevis) extensor compartments in the dorsoradial aspect of the distal forearm. Imaging modalities used to diagnosis this syndrome include ultrasonography (US) and magnetic resonance imaging. The purpose of this report is to describe typical US findings in the intersection syndrome and to demonstrate the diagnostic value of this approach. MATERIALS AND METHODS We reviewed US findings in 4 patients (mean age 40 years) referred to our staff for symptoms suggestive of the intersection syndrome (pain, swelling, erythema, and edema of the wrist). RESULTS In all 4 cases, the US examination revealed peritendinous edema and synovial fluid within the tendon sheaths at the intersection between the first and the second dorsal extensor tendon compartments. DISCUSSION Our experience shows that the intersection syndrome is associated with typical signs on US. This imaging modality can be considered a reliable tool for diagnosing this syndrome and may eliminate the need for other more expensive tests.
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Affiliation(s)
- S Montechiarello
- Department of Radiological Sciences, University Hospital Policlinico Umberto I, Rome, Italy
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Buck FM, Gheno R, Nico MAC, Haghighi P, Trudell DJ, Resnick D. Chiasma crurale: intersection of the tibialis posterior and flexor digitorum longus tendons above the ankle. Magnetic resonance imaging-anatomic correlation in cadavers. Skeletal Radiol 2010; 39:565-73. [PMID: 19876626 PMCID: PMC2856856 DOI: 10.1007/s00256-009-0817-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 10/02/2009] [Accepted: 10/05/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the precise anatomy and magnetic resonance (MR) imaging appearance of the chiasma crurale in cadavers, paying special attention to degenerative changes MATERIAL AND METHODS Twelve fresh human ankles were harvested from 11 nonembalmed cadavers (mean age at death 77 years) and used according to institutional guidelines. MR imaging and MR tenography were used to investigate the anatomy of the chiasma crurale using proton density-weighted sequences. The gross anatomy of the chiasma crurale was evaluated and compared to the MR imaging findings. Histology was used to elucidate further the structure of the chiasma crurale. RESULTS Above the chiasma, five specimens had a small amount of fat tissue between the tibialis posterior and flexor digitorum longus tendon. In all specimens both tendons had a sheath below the chiasma but not above it. At the central portion of the chiasma there was no soft tissue between the tendons, except in two specimens that showed an anatomic variant consisting of a thick septum connecting the tibial periosteum and the deep transverse fascia of the leg. In MR images, eight specimens showed what were believed to be degenerative changes in the tendons at the level of the chiasma. However, during gross inspection and histologic analysis of the specimens, there was no tendon degeneration visible. CONCLUSION At the central portion of the chiasma, there is no tissue between the tibialis posterior and flexor digitorum longus tendons unless there is an anatomic variant. At the chiasma crurale, areas with irregular tendon surfaces are normal findings and are not associated with tendon degeneration (fraying).
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Affiliation(s)
- Florian M. Buck
- Department of Radiology, VA San Diego Medical Center, San Diego, CA USA ,Present Address: Institut für Diagnostische Radiologie, Uniklinik Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Ramon Gheno
- Department of Radiology, VA San Diego Medical Center, San Diego, CA USA
| | | | - Parviz Haghighi
- Department of Pathology, VA San Diego Medical Center, San Diego, CA USA
| | - Debra J. Trudell
- Department of Radiology, VA San Diego Medical Center, San Diego, CA USA
| | - Donald Resnick
- Department of Radiology, VA San Diego Medical Center, San Diego, CA USA
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De Maeseneer M, Marcelis S, Jager T, Girard C, Gest T, Jamadar D. Spectrum of normal and pathologic findings in the region of the first extensor compartment of the wrist: sonographic findings and correlations with dissections. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:779-786. [PMID: 19470818 DOI: 10.7863/jum.2009.28.6.779] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this presentation is to review pathologic conditions that lead to pain at the radial aspect of the distal radius and to address anatomic variations of the first extensor compartment that exist and may have diagnostic and therapeutic implications. METHODS Our presentation is based on a review of cases from teaching files and observations made in anatomic specimens. RESULTS The discussed conditions include de Quervain tenosynovitis, intersection syndrome, and Wartenberg syndrome. Sonographic diagnosis of these conditions is addressed, and correlations are provided with anatomic specimens. CONCLUSIONS Sonography is able to depict and differentiate between these conditions.
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Affiliation(s)
- Michel De Maeseneer
- Department of Radiology, Wake Forest University Hospital, Medical Center Boulevard, Winston-Salem, NC 27157-1088, USA.
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Harish S, O'Neill J, Finlay K, Jurriaans E, Friedman L. Ultrasound of Wrist Pain. Curr Probl Diagn Radiol 2009; 38:111-25. [DOI: 10.1067/j.cpradiol.2008.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lee RP, Hatem SF, Recht MP. Extended MRI findings of intersection syndrome. Skeletal Radiol 2009; 38:157-63. [PMID: 18810435 DOI: 10.1007/s00256-008-0587-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 08/18/2008] [Accepted: 08/21/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The symptoms and physical findings of intersection syndrome have been well described in the clinical medical literature. However, the magnetic resonance imaging (MRI) findings in patients with intersection syndrome of the forearm have only recently been described in a small number of patients. We review our experience with imaging of intersection syndrome, describe previously unreported MRI findings, and emphasize modifications to MRI protocols for its evaluation. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective review of patients with MRI findings consistent with intersection syndrome of the forearm during the period from January 2004 to September 2006. Six patients were identified, three males and three females, with an average age of 39.3 years. The MRI examinations were reviewed to assess signal abnormalities within and adjacent to the first and second dorsal extensor tendon compartments (DETC): tendinosis, peritendinous edema or fluid, muscle edema, subcutaneous edema, and juxtacortical edema. The overall longitudinal extent of signal alterations was measured as well as the distance from Lister's tubercle to the crossover of the first and second DETC. RESULTS Review of the MRIs showed increased intrasubstance tendon signal suggesting tendinosis in two of the six patients, peritendinous edema or fluid in all six patients, muscle edema in five of the six patients, and subcutaneous edema in three of the six patients. Juxtacortical edema was seen in one patient. Peritendinous edema or fluid extended distally beyond the radiocarpal joint in three of the six patients. The average distance from Lister's tubercle to the crossover of the first and second DETC was 3.95 cm, in keeping with recently published data. CONCLUSION Intersection syndrome is an uncommon MRI diagnosis. In addition to the previously described MRI findings of edema adjacent to the first or second DETC, possibly with proximal extension and subcutaneous edema, we have identified additional abnormalities: tendinosis, muscle edema, and juxtacortical edema. In addition, our review shows that first and second DETC signal abnormalities in patients with intersection syndrome are not necessarily limited to the site of crossover but can extend distally beyond the radiocarpal joint. As standard wrist protocols may not include the area of intersection between the first and second DETC, coverage may need to be extended to the mid-forearm.
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Affiliation(s)
- Roger P Lee
- Cleveland Clinic, 9500 Euclid Avenue, Desk A21, Cleveland, OH 44195, USA
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Leproust H, Roure P, Ronan C, Roquelaure Y, Descatha A. Syndrome du croisement et ses liens avec le travail. ARCH MAL PROF ENVIRO 2008. [DOI: 10.1016/j.admp.2008.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Descatha A, Leproust H, Roure P, Ronan C, Roquelaure Y. Is the intersection syndrome is an occupational disease? Joint Bone Spine 2008; 75:329-31. [DOI: 10.1016/j.jbspin.2007.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 05/19/2007] [Indexed: 12/18/2022]
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Communicating foramen between the tendon sheaths of the extensor carpi radialis brevis and extensor pollicis longus muscles: imaging of cadavers and patients. AJR Am J Roentgenol 2007; 189:1190-7. [PMID: 17954660 DOI: 10.2214/ajr.07.2281] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the anatomic features and imaging appearance of the intersection of the extensor pollicis longus (EPL) tendon with the extensor carpi radialis brevis (ECRB) and longus (ECRL) tendons in cadavers and patients. MATERIALS AND METHODS MR and CT tenography were performed on 10 cadaveric wrists, and tenosynovial endoscopy and dissection of the EPL tendon sheath were performed on five additional cadaveric wrists. A computer-assisted search of dictated MRI reports identified 12 wrists of patients with simultaneous EPL tenosynovitis and ECRB and ECRL tenosynovitis. The relation between EPL tenosynovitis and ECRB and ECRL tenosynovitis was studied with chi-square testing. Interobserver agreement was calculated with kappa statistics. RESULTS MR and CT tenography revealed a communicating foramen between the sheaths of the ECRB and EPL tendons in all 10 cadavers studied. Endoscopic evaluation and dissection of five additional cadaveric wrists further confirmed the presence of foramina. In the patients, the presence of EPL tenosynovitis and that of ECRB and ECRL tenosynovitis had strong correlation (p < 0.001). The incidence of simultaneous EPL tenosynovitis and ECRB and ECRL tenosynovitis in our referral population of wrist MRI examinations was 0.8% (12/1,540). CONCLUSION A normal foramen exists between the sheaths of the EPL and ECRB tendons where they intersect in the wrist. Such foramina allow synovial fluid to communicate between the tendon sheaths and probably account for the high prevalence of tenosynovitis in more than one tendon on clinical MRI studies.
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Parellada AJ, Gopez AG, Morrison WB, Sweet S, Leinberry CF, Reiter SB, Kohn M. Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features. Skeletal Radiol 2007; 36:203-8. [PMID: 17177022 DOI: 10.1007/s00256-006-0238-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 10/11/2006] [Accepted: 10/17/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To present the MRI imaging findings of extensor tenosynovitis at the distal intersection or crossover between the second (extensor carpi radialis longus (ECRL) and brevis (ECRB)) and third (extensor pollicis longus (EPL)) extensor compartment tendons, and the anatomical details that may play a role in the pathogenesis of this condition. DESIGN AND PATIENTS The imaging studies and clinical records of five patients (three females and two males, with ages ranging between 22 and 78 years; mean age, 49 years) presenting with pain on the dorsal and radial aspect of the wrist were reviewed by two musculoskeletal radiologists in consensus. Three cases were identified serendipitously during routine clinical reading sessions; a follow-up computerized database search for additional cases reported in the prior two years yielded two additional cases. The overall number of cases screened was 1,031. The diagnosis of tendinopathy affecting the second and third compartment extensor tendons was made on the basis of MRI findings and clinical follow-up, or synovectomy. RESULTS All patients showed signs of tenosynovitis: in four patients both the tendons of the second and third extensor compartments were affected; the fifth patient showed signs of tenosynovitis of the EPL tendon, and tendinosis of the extensor carpi radialis tendons. Three patients showed tenosynovitis proximal and distal to the point of intersection; and in two of them, a discrete point of constriction was appreciated at the crossover site in relation to the extensor retinaculum. Two patients showed tenosynovitis limited to the segment distal to the point of decussation. Tendinosis tended to follow the presence of tenosynovitis. In one of the patients, subtendinous reactive marrow edema in Lister's tubercle was noted. CONCLUSION Distal intersection tenosynovitis may be related to the biomechanical pulley effect exerted by Lister's tubercle on the EPL tendon as it leaves the third compartment and crosses over the extensor carpi radialis tendons, as well as the constraining effect of the extensor retinaculum. These anatomical features determine the presence of characteristic MR imaging findings.
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Bencardino JT, Rosenberg ZS. Sports-Related Injuries of the Wrist: An Approach to MRI Interpretation. Clin Sports Med 2006; 25:409-32, vi. [PMID: 16798135 DOI: 10.1016/j.csm.2006.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sports-related injuries to the wrist range from minor sprains to severe soft tissue disruption that can pose a risk to the normal function of the upper extremity. It is important to identify the specific nature of such injuries so as to establish an accurate diagnosis and deliver appropriate treatment. MRI of the wrist has greatly benefited from the use of dedicated surface coils, which allow fine depiction of soft tissue and cartilaginous structures. A review of the normal anatomy, MR interpretation pitfalls, and most common abnormalities of the tendons, ligaments, triangular fibrocartilage complex, and nerves of the wrist are presented.
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Affiliation(s)
- Jenny T Bencardino
- Department of Radiology, Huntington Hospital, North Shore Long Island Jewish Health System, 270 Park Avenue, Huntington, NY 11747, USA.
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