![]() Proximal intersection syndrome-Proximal intersection syndrome occurs where the APL and EPB myotendinous junctions cross over the ECRL and ECRB. Treatment is typically conservative and includes rest and oral antiinflammatory medications such as NSAIDs or steroids. ![]() 3B -44-year-old man with distal intersection syndrome.ī, Axial T2-weighted fat-suppressed MR image of same patient shows fluid distending tendon sheaths ( asterisk) as they cross and adjacent soft-tissue edema ( arrow). Associated tendinopathy may be present, ranging from thickening to longitudinal split tearing.įig. Edema can be seen within the adjacent bones, soft-tissue structures, or both. 2 ) show hyperintense signal within the EPB and APL tendon sheaths, reflecting distention by fluid and inflammatory cells. Radiographs of the wrist often have nondiagnostic findings, but they may show nonspecific findings such as soft-tissue swelling and cortical irregularity at the radial styloid. The condition de Quervain tenosynovitis is characterized by EPB and APL tendinosis with peritendinous edema, inflammation, and hyperemia. On clinical examination, a Finkelstein test, in which pain is elicited on passive ulnar deviation while the thumb is adducted, is commonly used to evaluate for this condition, but the finding is not always positive. Pain radiates into the forearm, hand, and thumb with associated local swelling and tenderness. Patients present with pain at the radial aspect of the wrist, which is exacerbated by thumb adduction and ulnar deviation of the wrist. This pathophysiologic finding, known as stenosing tenosynovitis, can be seen elsewhere throughout the body as well, where tendons are covered by their own fibroosseous sheaths. īecause both the EPB and the APL course deep to the extensor retinaculum within a fibroosseous groove along the radial styloid process, thickening of the extensor retinaculum and inflammation of the tendon sheaths related to repetitive injury preclude smooth gliding of the tendons. More recently, individuals who frequently send text messages have also become susceptible to this condition. This chronic overuse injury most commonly affects women (particularly new mothers) and athletes who are involved in racquet sports, fishing, and golf. ![]() The condition known as de Quervain tenosynovitis, a stenosing tenosynovitis that affects the EPB and APL, was first described by Fritz de Quervain in 1895. These synovial sheaths traverse through the fibroosseous tunnels formed by the extensor retinaculum at the level of the distal radioulnar joint (DRUJ), organized in six distinct anatomic compartments. As the tendons near and course over the wrist, they are covered by synovial sheaths formed from the outer layer of each individual tendon ( Fig. The tendons originate in the forearm and course across the wrist to insert on their target of motion. Furthermore, anatomic prominences, osseous deformities related to prior fracture, and bony changes caused by osteoarthritis can result in tendon attrition and eventual rupture. Because of their superficial location, isolated tears of any of these tendons can occur as a result of lacerations, crush injuries, burns, and bites. Tenosynovitis may also result from an inflammatory process or infection. Injury to these tendons is often the result of repetitive trauma and overuse and most commonly presents as tendinosis and tenosynovitis. Nine major extensor tendons are located at the dorsal aspect of the wrist. MRI of the wrist is commonly performed to evaluate individuals with wrist pain, allowing detailed anatomic evaluation and accurate characterization of wrist abnormalities, including those involving the dorsal extensor wrist tendons.
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