HSS Ultrasound Case 76

Clinical History 76 year-old woman with right wrist pain and palpable mass at the volar radial wrist.

The patient was referred for a wrist ultrasound to assess for a ganglion cyst.

Ultrasound of the Month – Case 76

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Ultrasound of the Month – Case 76

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Diagnosis: Flexor Carpi Radialis Tenosynovitis Discussion The flexor carpi radialis (FCR) tendon has a complex insertion at the wrist, with the majority of the tendon (80%) inserting at the base of the 2nd metacarpal. 20% of the tendon insert on the 3rd metacarpal, and a few tendon slips attach to the trapezium.

The FCR tendon is encased in a sheath from the musculotendinous junction to the trapezium, and it is outside the carpal tunnel. When the tendon sheath is distended with fluid, this is called tenosynovitis.

FCR tenosynovitis is generally associated with two main conditions: • Overuse: Manual labor, golf or racquet sports • Arthritis: Radiocarpal or basilar joint arthritis Post-traumatic FCR tenosynovitis can also be seen after a scaphoid or distal radius fracture.

Treatment is usually non-operative and includes immobilization, non-steroidal anti-inflammatory medication (NSAIDs) and peritendinous corticosteroid injection. Ultrasound guidance is ideal for safe and accurate FCR peritendinous corticosteroid injection.

Ultrasound of the Month – Case 76

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