Click on Images for Enlarged View

Findings: T2-weighted (Figure 1) and T1-weighted post-gadolinium (Figure 2) axial images of the distal forearm and wrist are presented. These images demonstrate foci of bright T2 signal surrounding the extensor carpi radialis brevis and longus tendons and minimal brightening surrounding the extensor pollicis longus tendon. Following the intravenous administration of gadolinium the area around the extensor pollicis longus tendon enhances as does the area immediately surrounding the extensor carpi tendons. Just medial to the extensor carpi tendons is a large fluid collection with rim enhancement. The overall appearance is consistent with synovial inflammation surrounding the tendons with a focal inflammatory fluid collection. A second rim enhancing fluid collection is present flexor carpi ulnaris muscle.

Diagnosis: Infectious tenosynovitis/palmar abscess.

Discussion: In this patient the MR appearance is consistent with infectious tenosynovitis and abscess formation. This impression was confirmed at surgery. The appearance of the extensor tendons however is nonspecific and may be seen with an inflammatory arthritis mainly rheumatoid arthritis.

References:
Beltran J, Noto AM, McGhee RB, Freedy RM, McCalla MS. Infections of the
Musculoskeletal System: High-field-strength MR Imaging. Radiology 1987; 164:449-454.

Rubens DJ, Blebea JS, Totterman SMS, Hooper MM. Rheumatoid Arthritis:
Evaluation of Wrist Extensor Tendons With Clinical Examination Versus MR Imaging - A Preliminary
Report. Radiology 1993; 187:831-838.

Return to Musculoskeletal Teaching File Page