40-year-old female with wrist pain



Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian


Case Section

Muskuloskeletal System


Patient's Information

Gender : Female
Age : 40


Clinical Summary

40-year-old female with wrist pain


Imaging Findings

Axial and coronal T1- and T2-weighted images show expansion of the first right extensor compartment included abductor pollicis longus and extensor pollicis brevis tendons on distal and dorsolateral aspect of radius styloid process associated with tendon sheeth thickening,greater on medial aspect of tendons.Corrosponding T2-weighted and STIR sequences demonstrate increased signal intensity in and around thickened tendon sheeth and adjacent subcutaneous fat.Lesser degrees of the same findings are seen on left side.


Differential Diagnosis



Final Diagnosis

De Quervain's tenosynovitis


Discussion (Related Text)

Typically, classic de Quervain’s tenosynovitis includes chronic inflammation scar formation with stenosis of the approximately 1-cm-long fibroosseous tunnel of the first dorsal compartment (the groove along the radial styloid process covered by the overlying extensor retinaculum through which the abductor pollicis longus and extensor pollicis brevis tendons run).Myxoid degeneration responsible for the thickening is observed in the sheath and intramural deposits of mucopolysaccharides predominantly within the subsynovial regions. This would account for the nonsharp margins of the tendon sheath and altered signal intensity within the adjacent subcutaneous fat on MRI. The radiologic differential diagnoses for these MRI findings include atypical infections, scaphoid fracture or nonunions or radioscaphoid arthritis, and trapeziometacarpal joint arthritis. However, with careful review of the wrist joint compartment anatomy with findings centered in and around the first extensor compartment, especially in the axial plane, and with exclusion of other osseous disorders in the coronal plane images, other diagnoses should be excluded.



AJR 2004;182:719–724


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