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