Clinical diagnosis
Case 283
【Progress】
He was given non-steroid anti-inflammatory drugs.
【Discussion】
There are six compartments at Lister tuberculum level. Lister tuberculum, radicular tuberculum divides the second compartment and the third compartment. The third compartment includes extensor pollicis longus and the second compartment includes extensor carpi radialis longus and extensor carpi radialis brevis. When unimaginably load is applied to these extensor muscle are applied, fracture of Lister tuberculum can occur (1).
The first compartment includes abductor pollicis longus muscle and extensor pollicis brevis, which is related to De Quervain syndrome (2). De quervain syndrome occurs in case of applying load to thumb such as supporting a baby, using smartphone, personal computer or playing a guitar or a piano (3). It pathologically indicates edematous thickness and myxoid degeneration of the tendon sheath (3, 4).
To interpretate MRI findings, first, T1WI is useful to identify Lister tuberculum and then second and third compartment, inducing to identify the first compartment. There are two muscle tendons of abductor pollicis longus muscle and extensor pollicis brevis muscle in the first component. The first compartment can be followed distally. Thereafter, using fat suppression T2WI, edematous change of the first compartment can be found, leading to diagnosis of De Quervain syndrome (4-6). Using this interpretation, it is possible to differentiate from other diseases such as Lister fracture and intersection syndrome.
Intersectional syndrome occurs by crossing between the first compartment and the second compartment. The first compartment includes abductor pollicis longus and extensor pollicis brevis muscle while the second compartment includes extensor carpi radialis longus and extensor carpi radialis brevis (7). The intersection site is more proximal to Lister tuberculum.
It can be differentiate between intersection syndrome and De Quervain syndrome by identifying whether the lesion is more proximal or peripheral from Lister tuberculum.
【Summary】
We presented a thirty two-year-old male presented in our hospital for left wrist pain. MRI depicted peritendinous edema identical to extensor pollicis brevis muscle (EPBM) and subcutaneous edema surrounding EPBM and abductor pollicis longus muscle (APLM), making an imaging diagnosis of De Quervain syndrome. It is borne in mind that the basic interpretation of the wrist is to find out Lister tuberculum on T1WI MRI which clearly demonstrates six compartments. Lister tuberculum divides the second compartment and the third compartment. De Quervain syndrome occurs more distal and intersection syndrome does more proximal. Meanwhile, fat suppression T2WI demonstrates edematous lesion more clearly with high signal intensity. By comparison with the image of T1WI, the presence or absence of edematous change can be judged. De Quervain syndrome is visualized as the edematous change of the sheath (first compartment) of EPBM and APLM.
【References】
1.Grundberg AB, et al. Pathologic anatomy of the forearm: intersection syndrome. J Hand Surg Am. 1985;10:299-302.
2.Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31 (2): 265-8. doi:10.1007/s00264-006-0165-0 - Free text at pubmed - Pubmed citation
3.Anderson SE, Steinbach LS, De Monaco D et-al. "Baby wrist": MRI of an overuse syndrome in mothers. AJR Am J Roentgenol. 2004;182 (3): 719-24. AJR Am J Roentgenol (full text) - Pubmed citation
4.Glajchen N et.al. MRI features in de Quervain's tenosynovitis of the wrist. (1996) Skeletal radiology.
5.Chien AJ, Jacobson JA, Martel W et-al. Focal radial styloid abnormality as a manifestation of de Quervain tenosynovitis. AJR Am J Roentgenol. 2001;177 (6): 1383-6. AJR Am J Roentgenol (full text) - Pubmed citation
6.McAuliffe JA. Tendon disorders of the hand and wrist. (2010) The Journal of hand surgery. 35 (5): 846-53; quiz 853. doi:10.1016/j.jhsa.2010.03.001 - Pubmed
7.Costa CR, et al. MRI Features of intersection syndrome of the Forearm. American Journal of Roentgenology. 2003;181: 1245-1249
2022.11.22