Dequervain’s Tenosynovitis-MRI

45 year old male with work place related repetitive stress of the wrist movement with ulnar deviation complaints of pain along the first dorsal extensor compartment and thumb with painful thumb abduction. MR shows free fluid along APL and EPB tendons with thickening of the APL with edema of the soft tissues in the vicinity with subtle cortical asymmetry of the lower radius on x-ray, suggesting Dequervain’s tenosynovitis. Case Submitted by Dr MGK Murthy, Mr Hari, Mr Charles

Teaching points:

§  Abductor pollicis longus (APL) and extensor pollicis breves (EPB) tendons pass through the fibroosseous canal created by extensor retinaculum and lower radius at the wrist joint.

§  Repetitive ulnar deviating abduction movement stress of the thumb as it occurs in work place activities or carrying of the baby,  atheletes , golf  or racquet sports etc could produces tenosynovitis of this kind. More common in females.

§  Finkelstein’s test clinically (ulnar deviation of the wrist with fist closed with flexion of the thumb) produces diagnostic pain.

§  X-ray could suggests periosteal or osteophyte response of the radius. Ultrasound could differentiate from intersection syndrome (usually occurs more proximally in the forearm). MR is usually diagnostic with presence of free fluid along the tendons and thickening of the tendons.