Flexor carpi radialis tunnel syndrome

Case contributed by Dr Matthew Smith

Presentation

Chronic volar wrist pain, elicited with resisted opposition

Patient Data

Age: 30 years
Gender: Male

MRI wrist

MRI

FCR tendon is surrounded by prominent tenosynovial fluid and T2 intermediate synovitis. The distal FCR tendon within the hand is flattened. Adjacent trapezial ridge exhibits mild reactivemarrow edema. Additional patchy marrow edema within the hamate and pisiform which is of unclear clinical significance. Triscaphe joint is normal (atypical for FCR tunnel syndrome).

FCR tunnel syndrome presents with volar wrist pain (red region). Imaging findings are depicted.

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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