Flexor carpi radialis tunnel syndrome

Case contributed by Matthew Smith
Diagnosis certain

Presentation

Chronic volar wrist pain, elicited with resisted opposition.

Patient Data

Age: 30 years
Gender: Male
This study is a stack
Axial T2
fat sat
This study is a stack
Coronal T2
fat sat
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Sagittal
T2 fat sat
This study is a stack
Axial
T1
This study is a stack
Coronal
T1
This study is a stack
Sagittal
T1
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Info

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 oedema immediately adjacent the FCR tendon.

Additional patchy marrow oedema within the hamate and pisiform is of unclear clinical significance. Triscaphe joint is normal (atypical for FCR tunnel syndrome).

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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 labour), triscaphe joint osteoarthritis

  • presentation: volar wrist tenderness

  • MRI: increased T2 signal around FCR sheath, adjacent reactive marrow oedema 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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