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Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features

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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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Authors and Affiliations

  1. DII—Diagnostic Imaging, Inc., Philadelphia, PA, USA

    Antoni J. Parellada, Sean B. Reiter & Mark Kohn

  2. Department of Radiology, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA, 19107, USA

    Angela G. Gopez & William B. Morrison

  3. The Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, PA, USA

    Stephanie Sweet

  4. Department of Orthopedic Surgery—Hand Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    Charles F. Leinberry

  5. Department of Radiology, Frankford Hospitals—Torresdale Campus, Red Lion and Knights Roads, Philadelphia, PA, 19114, USA

    Antoni J. Parellada

Authors
  1. Antoni J. Parellada
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  2. Angela G. Gopez
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  3. William B. Morrison
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  4. Stephanie Sweet
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  5. Charles F. Leinberry
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  6. Sean B. Reiter
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  7. Mark Kohn
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Correspondence to Antoni J. Parellada.

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Parellada, A.J., Gopez, A.G., Morrison, W.B. et al. Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features. Skeletal Radiol 36, 203–208 (2007). https://doi.org/10.1007/s00256-006-0238-6

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  • DOI: https://doi.org/10.1007/s00256-006-0238-6

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