Snapping wrist due to 3rd extensor compartment stenosing tenosynovitis
Presentation
Bilateral painful thumb movements with left wrist snapping - few weeks. No recent or remote trauma/ wrist fracture/ rheumatoid arthritis.
Patient Data
Dorsal wrist snapping
Thumb movement results in the wrist snapping at the 3rd extensor compartment location.
Severe thickening of the 3rd extensor compartment retinaculum located at and distal to the Lister's tubercle. It appears as the hypoechoic soft tissue thickening covering the tendon at the distal end of the radius. The cross-sectional area of the affected tendon segment is reduced to less than 50% compared to the unaffected segment. Intact tendon with a normal echopattern. No tendon sheath effusion. Dynamic scan shows tendon snapping through the narrow lumen under the thickened retinaculum.
The contralateral side also shows 3rd extensor compartment retinacular thickening. However, there is no tendon snapping during the dynamic scan. Normal tendon echopattern. No tendon sheath effusion.
For comparison, I examined my asymptomatic left wrist. There is a normal thickness of the 3rd extensor compartment retinaculum.
Case Discussion
A professional photographer presented with painful movements of both thumbs affecting his work. The ultrasound shows stenosing tenosynovitis of 3rd extensor compartment of both wrists. An additional finding of extensor pollicis longus tendon snapping is present on the left side.
Stenosing tenosynovitis most commonly involves the 1st extensor compartment which is known as De Quervain tenosynovitis. Involvement of the 3rd compartment is rare in non-rheumatoid patients1.
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