Andrei pointed out what I tried to express….though I think my response was not clear in the summary.In the static Ax image with supination, the degree of ECU subluxation remains stable…I would have expected it to increase in that position.
Like Andrei, I wonder if the subsheath is partially torn or stretched.
I do wonder if real time dynamic US would not be more accurate to assess the degree of instability
To differentiate normal bifid tendon slips from tear, you would trace back along the proximal tendon…..if it is new at the level of the distal tendon, it is a tear.
This is easily accomplished using US.
It’s a bit hard to notice in the movie of the dynamic US I posted…but in real time, the deep surface partial tear opened up and caught on the edge of the ulnar styloid on relocation into the groove.
That wrist went to surgery.
Thank you to André Gomes for bringing attention to the new OCAD LinkedIn page
I am trying to highlight interesting cases from the website archive and current posts (all with permission)
The goal is to increase outreach
Please check out the page if you have a LinkedIn account….follow it, repost….do whatever it is people do on social media…..I’m just learning!
Andrei Dumitrescu: Thanks Andre for the feedback f/u and the additional scans. As expected supination scans show more marked subluxation of the tendon which however is not totally out of the groove, thus casting some doubt on the supposed complete subsheath tear… although morphologically it’s hard to deny an ulnar sided discontinuity. The tendon shows an intratendinous split lesion, or a bifid appearance (a normal variant Dr. H. Umans once poined out to me). My personal take home message from this great case is to do additional supination scans in such patients.Freundliche Grüsse Laith Alhyari, M.D. I think it is a partial tear. Best wishes!
Damon Sacco:Thanks for the information and case. Something I have probably under called over the years.
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.
