Partial extensor carpi radialis brevis tendon tear

incl. tenosynovitis, tendinopathy and severe neovascularization

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Clinical information

The past 2 months the patient had pain on the dorsoradial and radial side of the wrist. The pain radiated in the extensor muscles up to the lateral side of the elbow. The patient can't remember the potential cause of this problem. The patient reports a VAS 7 during wrist movements, especially when making a dorsalflexion.

Brief description

The transducer was placed both transverse (short-axis) and longitudinally (long-axis) over the second extensor compartment. The extensor carpi radialis brevis (ECRB) was visualized and followed to distal at the level of the radiocarpal and midcarpal joint (lunate and capitate bones). Images were analyzed by using the SonoSkills pathology checklist.

SHAPE: The tendon of the ECRB appears to be thickened and shows a larger cross-sectional area (CSA) especially at the level of the lunate and capitate bone. The tendon retinaculum also appears to have thickened.
ECHOGENICITY: The echogenicity is quite inhomogeneous. The tendon shows more hypoechoic zones, but also anechoic zones. The echogenicity was better to identify with the 18 Mhz hockestick transducer.
CONTINUITY: There appears to be a zone in the central deep ECRB tendon which shows a fibre disruption, most likely a partial tear.
DOPPLER: power Doppler shows a severe case of neovascularization intra-tendinous, but also in the retinaculum.
FUNCTIONAL: no ultrasound guided functional test could be executed.

Ultrasound Images & Clips

Transverse: extensor compartments 2, 3, 4 and 5 at Listers tubercle level.

Transverse: extensor compartment 2 at Listers tubercle level.

Transverse: ECRB tendon slightly distal of extensor compartment 2 (linear 15Mhz transducer).

Transverse: power Doppler of ECRB tendon (linear 15Mhz transducer).

Transverse: left/right comparison of ECRB tendon (linear 15Mhz transducer).

Transverse: ECRB tendon slightly distal of extensor compartment 2 (18Mhz hockeystick transducer).

Transverse: power Doppler of ECRB tendon (18Mhz hockeystick transducer).

Longitudinal: ECRB tendon slightly distal of extensor compartment 2, at level of radiocarpal joint (linear 15Mhz transducer).

Longitudinal: power Doppler ECRB tendon (linear 15Mhz transducer).

Longitudinal: left/right comparison of ECRB tendon (linear 15Mhz transducer).

Longitudinal: power Doppler left/right comparison of ECRB tendon (linear 15Mhz transducer).

Longitudinal: ECRB tendon slightly distal of extensor compartment 2, at level of radiocarpal joint (18Mhz hockeystick transducer).

Longitudinal: power Doppler of ECRB tendon (18Mhz hockeystick transducer).

Conclusion

Based on the ultrasound findings and SonoSkills pathology checklist analysis I concluded:

Tenosynovitis extensor compartment 2
Partial tear extensor carpi radialis brevis tendon
Tendinopathy extensor carpi radialis brevis tendon
Severe presence of neovascularization

Details

Sex: Male
Age: 63
Body part: Left wrist

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Author

Marc Schmitz

MSK Sonographer, SonoSkills

Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at the Laurentius Hospital in Roermond, the Netherlands.

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