Case Of the Week (COW) 17 January 2016
De Quervain tenosynovitis
Findings:
Increased fluid with debris within tendon sheath of APL and EPB tendons - tenosynovitis. Thickened oedematous retinaculum. Peritendinous subcutaneous oedema. Minimal tendon enlargement - tendinosis. APL shows linear high T2 signal due to fluid within - longitudinal tendon tear.
Discussion:
De Quervain tenosynovitis( washerwoman's sprain/strain)is a painful stenosing tenosynovitis involving the first extensor (dorsal) tendon compartment of the wrist (typically at the radial styloid). This compartment contains the abductor pollicis longus and extensor pollicis brevis tendons. The APL and EPB tendons are tightly secured against the radial styloid by the overlying extensor retinaculum which creates a fibro-osseous tunnel. Thickening of the retinaculum and tendons from acute or repetitive trauma restrains normal gliding within the sheath. This causes inflammation and further oedematous thickening of the tendon exacerbating the local stenosing effect. Microscopically there are inflammatory cells found within the tendon sheath.
Contributed By:
Dr Balaji Ayyamperumal
Tanjavur Medical College
De Quervain tenosynovitis
Findings:
Increased fluid with debris within tendon sheath of APL and EPB tendons - tenosynovitis. Thickened oedematous retinaculum. Peritendinous subcutaneous oedema. Minimal tendon enlargement - tendinosis. APL shows linear high T2 signal due to fluid within - longitudinal tendon tear.
Discussion:
De Quervain tenosynovitis( washerwoman's sprain/strain)is a painful stenosing tenosynovitis involving the first extensor (dorsal) tendon compartment of the wrist (typically at the radial styloid). This compartment contains the abductor pollicis longus and extensor pollicis brevis tendons. The APL and EPB tendons are tightly secured against the radial styloid by the overlying extensor retinaculum which creates a fibro-osseous tunnel. Thickening of the retinaculum and tendons from acute or repetitive trauma restrains normal gliding within the sheath. This causes inflammation and further oedematous thickening of the tendon exacerbating the local stenosing effect. Microscopically there are inflammatory cells found within the tendon sheath.
Contributed By:
Dr Balaji Ayyamperumal
Tanjavur Medical College