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European Radiology

, Volume 21, Issue 1, pp 160–166 | Cite as

Athletic injuries of the extensor carpi ulnaris subsheath: MRI findings and utility of gadolinium-enhanced fat-saturated T1-weighted sequences with wrist pronation and supination

  • Jeremy Jeantroux
  • Fabio Becce
  • Henri Guerini
  • Bernard Montalvan
  • Dominique Le Viet
  • Jean-Luc DrapéEmail author
Musculoskeletal

Abstract

Objective

To report the magnetic resonance imaging (MRI) findings in athletic injuries of the extensor carpi ulnaris (ECU) subsheath, assessing the utility of gadolinium-enhanced (Gd) fat-saturated (FS) T1-weighted sequences with wrist pronation and supination.

Methods

Sixteen patients (13 male, three female; mean age 30.3 years) with athletic injuries of the ECU subsheath sustained between January 2003 and June 2009 were included in this retrospective study. Initial and follow-up 1.5-T wrist MRIs were performed with transverse T1-weighted and STIR sequences in pronation, and Gd FS T1-weighted sequences with wrist pronation and supination. Two radiologists assessed the type of injury (A to C), ECU tendon stability, associated lesions and rated pulse sequences using a three-point scale: 1 = poor, 2 = good and 3 = excellent.

Results

Gd-enhanced FS T1-weighted transverse sequences in supination (2.63) and pronation (2.56) were most valuable, compared with STIR (2.19) and T1-weighted (1.94). Nine type A, one type B and six type C injuries were found. There were trends towards diminution in size, signal intensity and enhancement of associated pouches on follow-up MRI and tendon stabilisation within the ulnar groove.

Conclusion

Gd-enhanced FS T1-weighted sequences with wrist pronation and supination are most valuable in assessing and follow-up athletic injuries of the ECU subsheath on 1.5-T MRI.

Keywords

Extensor carpi ulnaris Tendon Athletic injuries Wrist Magnetic resonance imaging 

Notes

Acknowledgements

We gratefully thank Oren Semoun for assistance with his statistical analysis and Jérémie Uldry for his computer graphics work.

References

  1. 1.
    Spinner M, Kaplan EB (1970) Extensor carpi ulnaris. Its relationship to the stability of the distal radio-ulnar joint. Clin Orthop Relat Res 68:124–129CrossRefPubMedGoogle Scholar
  2. 2.
    Taleisnik J, Gelberman RH, Miller BW, Szabo RM (1984) The extensor retinaculum of the wrist. J Hand Surg Am 9:495–501PubMedGoogle Scholar
  3. 3.
    Montalvan B, Parier J, Brasseur JL, Le Viet D, Drape JL (2006) Extensor carpi ulnaris injuries in tennis players: a study of 28 cases. Br J Sports Med 40:424–429CrossRefPubMedGoogle Scholar
  4. 4.
    Burkhart SS, Wood MB, Linscheid RL (1982) Posttraumatic recurrent subluxation of the extensor carpi ulnaris tendon. J Hand Surg Am 7:1–3PubMedGoogle Scholar
  5. 5.
    Cone RO, Szabo R, Resnick D, Gelberman R, Taleisnik J, Gilula LA (1983) Computed tomography of the normal soft tissues of the wrist. Invest Radiol 18:546–551CrossRefPubMedGoogle Scholar
  6. 6.
    Pfirrmann CW, Theumann NH, Chung CB, Botte MJ, Trudell DJ, Resnick D (2001) What happens to the triangular fibrocartilage complex during pronation and supination of the forearm? Analysis of its morphology and diagnostic assessment with MR arthrography. Skeletal Radiol 30:677–685CrossRefPubMedGoogle Scholar
  7. 7.
    Elder G, Harvey AJ (2005) Hand and wrist tendinopathies. In: Maffulli N, Renström P, Wayne B (eds) Tendon injuries: basic science and clinical medicine, 3rd edn. Springer, London, pp 137–149Google Scholar
  8. 8.
    Rettig AC (2004) Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med 32:262–273CrossRefPubMedGoogle Scholar
  9. 9.
    Inoue G, Tamura Y (2001) Surgical treatment for recurrent dislocation of the extensor carpi ulnaris tendon. J Hand Surg Br 26:556–559PubMedGoogle Scholar
  10. 10.
    Pratt RK, Hoy GA, Bass Franzcr C (2004) Extensor carpi ulnaris subluxation or dislocation? Ultrasound measurement of tendon excursion and normal values. Hand Surg 9:137–143CrossRefPubMedGoogle Scholar
  11. 11.
    MacLennan AJ, Nemechek NM, Waitayawinyu T, Trumble TE (2008) Diagnosis and anatomic reconstruction of extensor carpi ulnaris subluxation. J Hand Surg Am 33:59–64CrossRefPubMedGoogle Scholar
  12. 12.
    Lee KS, Ablove RH, Singh S, De Smet AA, Haaland B, Fine JP (2009) Ultrasound imaging of normal displacement of the extensor carpi ulnaris tendon within the ulnar groove in 12 forearm-wrist positions. AJR Am J Roentgenol 193:651–655CrossRefPubMedGoogle Scholar
  13. 13.
    Rayan GM (1983) Recurrent dislocation of the extensor carpi ulnaris in athletes. Am J Sports Med 11:183–184CrossRefPubMedGoogle Scholar
  14. 14.
    Beckenbaugh RD (1987) Acute traumatic subluxation. J Hand Surg Am 12:810–811PubMedGoogle Scholar
  15. 15.
    Rowland SA (1986) Acute traumatic subluxation of the extensor carpi ulnaris tendon at the wrist. J Hand Surg Am 11:809–811PubMedGoogle Scholar
  16. 16.
    Allende C, Le Viet D (2005) Extensor carpi ulnaris problems at the wrist—classification, surgical treatment and results. J Hand Surg Br 30:265–272CrossRefPubMedGoogle Scholar
  17. 17.
    Eckhardt WA, Palmer AK (1981) Recurrent dislocation of extensor carpi ulnaris tendon. J Hand Surg Am 6:629–631PubMedGoogle Scholar
  18. 18.
    Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220CrossRefPubMedGoogle Scholar
  19. 19.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Jeremy Jeantroux
    • 1
  • Fabio Becce
    • 1
    • 2
  • Henri Guerini
    • 1
  • Bernard Montalvan
    • 3
  • Dominique Le Viet
    • 4
  • Jean-Luc Drapé
    • 1
    Email author
  1. 1.Department of Radiology B, Hôpital Cochin, AP-HPUniversité Paris DescartesParisFrance
  2. 2.Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire VaudoisUniversity of LausanneLausanneSwitzerland
  3. 3.French Tennis FederationParisFrance
  4. 4.Hand Institute, Clinique JouvenetParisFrance

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