Male, 34 years old, semi-professional tennis player.
Disabling pain on the ulnar edge of the wrist, making it impossible to play tennis.
Tendinopathy and marked tenosynovitis of the extensor carpi ulnaris with slight subluxation.
Signs of subsheath injury (yellow arrows) deep to the extensor retinaculum.
Anyone with experience in this diagnosis? Other ideas?
For portuguese-speaking radiologists, how can we translate subsheath?
Bainha fibrosa? Bainha fibro-óssea?
https://pubmed.ncbi.nlm.nih.gov/29922530
https://radsource.us/extensor-carpi-ulnaris-subsheath-injury
Kind regards.
André
Hi everyone !!
I´m sending you supination sequences above!
The question, if it really matters, is a complete tear ou parcial subsheath injury?
What do you think?
Thanks for all your comments:
Hilary: Definitely what it is, nice case.
It’s fun and informative to do dynamic US with the probe in transverse plane over the dorsal groove….stabilize the probe as the patient supinates and pronates….I’m sure it will sublux more or dislocate
You know the subsheath is torn….but there is a ? low grade split at the deep surface that might open up with the dynamic exam
Not sure it will change management, though
You know the subsheath is torn….but there is a ? low grade split at the deep surface that might open up with the dynamic exam. Not sure it will change management, though.
I don’t know what to think….it doesn’t change the degree of subluxation—-and supination should make it worse.
Maybe it’s just a small delaminating tear with a tiny pouch without a focal defect.
Atul K. Taneja: Belo caso Andre! No BR, a gente usa “sub-bainha tendinea”.
Rube: I’ve seen a couple— surgeon wants to know if it a complete tear of sub sheath necessitating surgery.
This one looks partial, with degenerated ECU not totally out of the groove.
John Rothpletz: I have made that diagnosis on non contrast scans a few times over the years (also referencing the same article you referenced) in similar clinical situations with the slightly subluxed tendon as in your example. Your case is even better showing the enhancement.
I would report this as ‘tenosynovitis with subluxed ECU tendon indicative of subsheath tear’.
I do not know of any other differential consideration, and will be interested to see if anyone in the group has another idea.
Svetla Balabano: Hi,In my opinion ECU tendon is slightly subluxed and it contains a small interstitial split. The subsheath appears disorganized at its palmar attachment, it is ill defined and torn -ulnar sided tear of the subsheath. Adjacent fluid and edema is shown. Regards.
Andrei Dumitres: I would have described it exactly the same. Thanks for the case! Best.
Anees Jwa: It is a common injury, thanks.I saw one last week.
Supination sequences :