De Quervain's tenosynovitis
Wrist pain and swelling.
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There is circumferential fluid with few septations seen in the tendon sheath of the first extensor compartment with surrounding soft tissue edema. In addition, there is tendinosis of the first compartment tendons manifested by thickening and intermediate signal intensity. These findings are in keeping with de Quervain tenosynovitis. The rest of extensor tendons and flexor tendons appear within normal limits.
There is intermediate T2 signal intensity involving triangular fibrocartilage with probable partial tear involving foveal insertion and meniscus homolog. There are edema and subchondral cystic changes involving ulnar aspect of lunate.
Tenosynovitis of the first extensor compartment is characteristic of De Quervain tenosynovitis and it is usually seen at the level of radial styloid. The finding is probably attributed to repetitive gliding of the tendons against the underlying bone. Some people may have complete septum between the two tendons and may require two separate steroid injections to treat the inflammation. Note that the appearance of several fascicles within the abductor pollicis tendon is considered a normal variant which can be mistaken for tendon tear.
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- Theumann NH, Pfirrmann CW, Drapé JL, Trudell DJ, Resnick D. MR imaging of the metacarpophalangeal joints of the fingers: part I. Conventional MR imaging and MR arthrographic findings in cadavers. (2002) Radiology. 222 (2): 437-45. doi:10.1148/radiol.2222010181 - Pubmed