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Flexor Carpi Radialis Tenosynovitis Mimicking Carpal Tunnel Syndrome Diagnosed and Monitored with Ultrasound: Case Report

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Abstract

The purpose of this report is to describe the value of ultrasound in diagnosing and monitoring flexor carpi radialis (FCR) tenosynovitis clinically mimicking carpal tunnel syndrome. A 62-year-old female had chronic right wrist pain with numbness and tingling in the first four digits. Physical examination suggested carpal tunnel syndrome. Ultrasound and power Doppler images demonstrated tenosynovitis of the FCR tendon, but a normal median nerve. Hyperemia was extending from the inflamed tendon to the adjacent median nerve, suggesting the FCR tenosynovitis was inducing a low-grade neuritis. Follow-up ultrasound at 3 weeks was performed due to worsening symptoms and demonstrated consistent tenosynovitis, prompting additional laboratory testing which excluded an inflammatory arthritis. More aggressive therapy was introduced at this time and repeat ultrasound 6 weeks later demonstrated near resolution of FCR tenosynovitis coinciding with symptom amelioration. This case underscores the value of ultrasound as an extension of the musculoskeletal examination to improve diagnostic specificity and guide appropriate care.

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References

  1. Luong DH, Smith J, Bianchi S. Flexor carpi radialis tendon ultrasound pictorial essay. Skelet Radiol. 2014;43(6):745–60. https://doi.org/10.1007/s00256-014-1846-1.

    Article  Google Scholar 

  2. Elder G, Harvey EJ. Hand and wrist tendinopathies. In: Maffulli N, Renström P, Leadbetter WB, editors. Tendon injuries. London: Springer; 2005. https://doi.org/10.1007/1-84628-050-8_15.

    Chapter  Google Scholar 

  3. Geannette C. Sonographic appearance of flexor carpi radialis tenosynovitis associated with a neuritis of the palmar cutaneous branch of the median nerve. Muscle Nerve. 2019;60(2):E10–1. https://doi.org/10.1002/mus.26508.

    Article  PubMed  Google Scholar 

  4. Kothari MJ. Carpal tunnel syndrome: clinical manifestations and diagnosis. In: UpToDate. Waltham MA: Ted W. Post; 2020. https://doi.org/10.14309/crj.0000000000000344.

    Chapter  Google Scholar 

  5. Doherty M. Clinical manifestations and diagnosis of osteoarthritis. In: UpToDate. Waltham MA: Ted W. Post; 2020.

    Google Scholar 

  6. Olubaniyi BO, Bhatnagar G, Vardhanabhuti V, Brown SE, Gafoor A, Suresh PS. Comprehensive musculoskeletal sonographic evaluation of the hand and wrist. J Ultrasound Med. 2013;32(6):901–14. https://doi.org/10.7863/ultra.32.6.901.

    Article  PubMed  Google Scholar 

  7. Sconfienza LM, et al. Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol. 2018;28(12):5338–51. https://doi.org/10.1007/s00330-018-5474-3.

    Article  PubMed  Google Scholar 

  8. Rubin DA. MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I Imaging findings Skeletal Radiol. 2019;48(5):677–95. https://doi.org/10.1007/s00256-019-03179-z.

    Article  PubMed  Google Scholar 

  9. Daenen B, Houben G, Bauduin E, Debry R, Magotteaux P. Sonography in wrist tendon pathology. J Clin Ultrasound. 2004;32(9):462–9. https://doi.org/10.1002/jcu.20071.

    Article  PubMed  Google Scholar 

  10. Sahbudin I, Pickup L, Nightingale P, Allen G, Cader Z, Singh R, et al. The role of ultrasound-defined tenosynovitis and synovitis in the prediction of rheumatoid arthritis development. Rheumatology (Oxford). 2018;1;57(7):1243–52. https://doi.org/10.1093/rheumatology/key025.

    Article  CAS  Google Scholar 

  11. Spinner RJ, Bachman JW, Amadio PC. The many faces of carpal tunnel syndrome. Mayo Clin Proc. 1989;64(7):829–36. Review. https://doi.org/10.1016/S0025-6196(12)61756-X.

    Article  CAS  PubMed  Google Scholar 

  12. Oh S, Kim HK, Kwak J, Kim T, Jang SH, Lee KH, et al. Causes of hand tingling in visual display terminal workers. Ann Rehabil Med. 2013;37(2):221–8. https://doi.org/10.5535/arm.2013.37.2.221.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Roomizadeh P, Eftekharsadat B, Abedini A, Ranjbar-kiyakalayeh S, Yousefi N, Ebadi S, et al. Ultrasonographic assessment of carpal tunnel syndrome severity: a systematic review and meta-analysis. Am J Phys Med Rehabil. 2019;98(5):373–81. https://doi.org/10.1097/PHM.0000000000001104.

    Article  PubMed  Google Scholar 

  14. McDonagh C, Alexander M, Kane D. The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm. Rheumatology (Oxford). 2015;54(1):9–19. https://doi.org/10.1093/rheumatology/keu275.

    Article  CAS  Google Scholar 

  15. Cartwright MS, Hobson-Webb LD, Boon AJ, Alter KE, Hunt CH, Flores VH, Werner RA, Shook SJ, Thomas TD, Primack SJ, Walker FO (2012) American Association of Neuromuscular and Electrodiagnostic Medicine. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve 46(2):287–293: https://doi.org/10.1002/mus.23389.

  16. Watson JC. The electrodiagnostic approach to carpal tunnel syndrome. Neurol Clin. 2012;30(2):457–78. https://doi.org/10.1016/j.ncl.2011.12.001.

    Article  PubMed  Google Scholar 

  17. Huisstede BM, Randsdorp MS, van den Brink J, Franke TPC, Koes BW, Hoogvliet P. Effectiveness of oral pain medication and corticosteroid injections for carpal tunnel syndrome: a systematic review. Arch Phys Med Rehabil. 2018;99(8):1609-1622.e10. https://doi.org/10.1016/j.apmr.2018.03.003.

    Article  PubMed  Google Scholar 

  18. Vögelin E, Nüesch E, Jüni P, Reichenbach S, Eser P, Ziswiler HR. Sonographic follow-up of patients with carpal tunnel syndrome undergoing surgical or nonsurgical treatment: prospective cohort study. J Hand Surg Am. 2010;35(9):1401–9. https://doi.org/10.1016/j.jhsa.2010.06.010.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Chiropractic Health Center, Logan University, 1851 Schoettler Road, Chesterfield, MO, 63017, USA

    Chandler L. Bolles, Ahmad Abdella & Patrick J. Battaglia

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  1. Chandler L. Bolles
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  2. Ahmad Abdella
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  3. Patrick J. Battaglia
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Correspondence to Chandler L. Bolles.

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The case presented does not include any experimental procedures involving humans or animals.

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Bolles, C.L., Abdella, A. & Battaglia, P.J. Flexor Carpi Radialis Tenosynovitis Mimicking Carpal Tunnel Syndrome Diagnosed and Monitored with Ultrasound: Case Report. SN Compr. Clin. Med. 2, 797–801 (2020). https://doi.org/10.1007/s42399-020-00320-1

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