OCAD MSK

History

54F 2 months dorsal pain and swelling, suspect ganglion

Figure 1 for case 4th extensor compartment tendinosis and stenosing tenosynovitis — Figure 1

Figure 2 for case 4th extensor compartment tendinosis and stenosing tenosynovitis — Figure 2

Figure 3 for case 4th extensor compartment tendinosis and stenosing tenosynovitis — Figure 3

Figure 4 for case 4th extensor compartment tendinosis and stenosing tenosynovitis — Figure 4

Discussion

The mass is centered over the CMC joints, and corresponds to stenosing tenosynovitis of the 4th extensor compartment. There is no ganglion (more commonly in proximity to the SLL). At the level of carpus, there is tendinosis and probable partial tearing of multiple common extensor tendons. At the level of the radiocarpal joint, all of the EDC tendons clump together, with enhancement of the thickened extensor retinaculum. There is pre-and post- stenotic dilation with effusion and enhancing synovium in the wrist and hand. This was referred by a hand surgeon. I have seen many cases like this on MRI and US and am always amazed that there is no suspicion of stenosing tenosynovitis and that ganglion is favored. I would imagine there would be painful limitation to finger extension. In this patient, there is no joint narrowing or articular synovitis. I have noticed this more commonly in women and am intrigued that the attached article implies that there may be some association to estrogen stimulation and deficits. Reference article.

Diagnosis

4th extensor compartment tendinosis and stenosing tenosynovitis

Hilary Umans, MD

Courtesy

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