Flexor tenosynovitis and palmar ulnar bursitis

Case contributed by Dr Dalia Ibrahim

Presentation

Middle finger and palm swelling as well as wrist pain of the right hand.

Patient Data

Age: 40 years
Gender: Male

Distension of the middle finger flexor tendon sheath and palmar bursae by fluid signal intensity and complex material consisting of numerous low signal foci (rice bodies).

Erosive arthropathic changes of the radiocarpal, inter-carpal, 2nd and 3rd metacarpophalangeal joints as well as the 3rd proximal inter-phalangeal joints evident by narrowing of their joint spaces, erosive changes and subchondral marrow degenerative changes of their articular surfaces.

Case Discussion

This is a known case of Rheumatoid arthritis.

Rheumatoid arthritis manifests mainly in the form of erosive arthropathic changes, especially of the wrist and hand joints. 

Manifestations also include tenosynovitis and palmar bursitis showing synovial proliferation, thickened enhancing synovium, and increased tenosynovial and bursal fluid volumes usually associated with tiny bodies of low signal (rice bodies).

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