Presentation
Pain at the base of the left thumb.
Patient Data
Marked thickening with increase density of the radial side soft tissues of the wrist
Significant tenosynovitis of the short extender and long abductor tendons. On T1 sequences they are thickened with increased signal; there's a small effusion associated with the corresponding synovial sheath.
There is also evidence of degeneration and fissure of the triangular fibrocartilage.
The semilunar and the ulnar styloid apophysis contain a small intra-bone ganglion associated with bone marrow edema.
Case Discussion
De Quervain's tenosynovitis is caused by an irritant or inflammation of the long abductor and short thumb extender tendons. This phlogistic process also involves the tendon sheath, which increases in volume. Because of the inflammatory state, it swells by compressing the tendons and increasing the irritating state. At the same time, edema can compress the radial nerve sensory branch, which runs slightly above the sheath, increasing pain and in more severe cases, resulting in loss of sensitivity of the thumb. Moreover, the synovium surrounding the tendons, due to inflammation, no longer produces the correct amount of synovial fluid necessary for lubricating them, further contributing to a worsening of the inflammatory state.
Case courtesy: Prof Fabio Denicolò
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