Presentation
Chronic volar wrist pain, elicited with resisted opposition.
Patient Data
FCR tendon is surrounded by prominent tenosynovial fluid and T2 intermediate synovitis. The distal FCR tendon within the hand is flattened. Mild trapezial ridge marrow edema immediately adjacent the FCR tendon.
Additional patchy marrow edema within the hamate and pisiform is of unclear clinical significance. Triscaphe joint is normal (atypical for FCR tunnel syndrome).
FCR tunnel syndrome presents with volar wrist pain (red region).
Case Discussion
The diagnosis was confirmed surgically. The operative report stated that after the fascia overlying the flexor carpi radialis tunnel was opened, a significant amount of tenosynovitis was encountered which was "red and angry" in appearance. There was no tendon rupture.
Key learning points:
risk factors: repetitive wrist flexion (golfers, racquet sports, manual labor), triscaphe joint osteoarthritis
presentation: volar wrist tenderness
MRI: increased T2 signal around FCR sheath, adjacent reactive marrow edema in the trapezial ridge
Additional learning points:
FCR tendonitis often secondary to triscaphe joint osteoarthritis, which can also lead to tendon tears
treatment may include rest/NSAIDs, corticosteroid injection, or surgical tunnel release
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