Since two week the patient had a swelling on his dorsal wrist, located around the proximal carpal row. The patient had pain (VAS 4) but experienced no functional limitations. He was referred by a general practitioner.
The transducer was placed both longitudinal (long-axis) and transverse (short-axis) over the 4th extensor compartment. The tendons of the compartment were followed to distal: the pathological changes were more prominent distally then proximally. A left/right comparison and power Doppler measurements where made. Furthermore, I scanned both statically and dynamically. A linear 15 Mhz transducer was used. Images were systematically analyzed by using the SonoSkills pathology checklist.
SHAPE: the tendons are increased in cross-sectional area (CSA) and thickness and the CSA of the 4th extensor compartment is enlarged.
ECHOGENICITY: The tendons present themselves much more hypo-echoic; a clear an-echoic effusion can be seen around the tendons.
CONTINUITY: No signs of any (fibre) disruptions of any particular structure can be seen.
DOPPLER: power Doppler shows a grade 3 (range 0-3) neovascularization. The location of the neovascularization is in the compartment walls, but also in and around the tendons within the compartment.
FUNCTIONAL: No functional limitations could be observed during ultrasound guided functional assessment.
Based on the ultrasound findings and SonoSkills pathology checklist analysis I concluded:
Moderate to severe effusion 4th extensor compartment
Tenosynovitis extensor digitorum communis
Tendinopathy extensor digitorum communis
Grade 3 neovascularization
Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at the Laurentius Hospital in Roermond, the Netherlands.
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