CASE 101
By: Dr. Aliya Sarhan Al Barwani
HISTORY: 40-year-old female with pain on the thumb during movement and mild swelling along the radius.
What are the findings?
What is the diagnosis?
How many extensor compartment we have?
FINDINGS:
The first extensor compartment (abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons) are enlarged and slightly high in signal in T2WI fat sat compared to other extensor tendons.
Mild Tenosynovitis.
Mild adjacent bone marrow edema.
DIAGNOSIS:
De Quervain tenosynovitis.
PEARLS AND DISCUSSION:
We have 6 extensor compartments and De Quervain’s involves the 1st extensor compartment. Tenosynovitis and tendinosis of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons are called De Quervain’s tenosynovitis. It is the most common entrapment tendinopathy in the hand after the trigger finger. Commonly seen in women in the middle age. It is associated with overuse or local trauma. Thickening and edema result in restriction of the normal gliding of the tendons through the first extensor fibro-osseous compartment.
On imaging, either ultrasound or MRI, it will show enlargement of the tendons with features of tendinosis, tenosynovitis and thickened extensor retinaculum at the level of radial styloid process. MRI can further show adjacent bone marrow edema.
FURTHER READING:
1. Diop AN, Ba-Diop S, Sane JC et-al. Role of US in the management of de Quervain's tenosynovitis: review of 22 cases. J Radiol. (2008)
2. Anderson SE, Steinbach LS and De Monaco. MRI of an overuse syndrome in mothers. AJR Am J Roentgenol. (2004)
3. Chien AJ and Jacobson JA. Focal radial styloid abnormality as a manifestation of de Quervain tenosynovitis. AJR Am J Roentgenol. (2001)
