Communicating Foramen Between the Tendon Sheaths of the Extensor Carpi Radialis Brevis and Extensor Pollicis Longus Muscles: Imaging of Cadavers and Patients

Cvitanic, Oliver; Henzie, Gregory M.; Adham, Medhi

doi:10.2214/ajr.07.2281

Cited by 22 publications

(17 citation statements)

References 10 publications

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“…Our case shows a cortical disruption in close relation with Lister's tubercle, supporting this hypothesis. A recent study suggests a communicating foramen between the tendon sheaths of the ECRB and the EPL (extensor compartment 2 and 3) [5]. We conclude from this that just one laceration to either the EPL or ECRB tendon sheath is needed to result in fat drops in both tendon sheaths.…”

Section: Discussionsupporting

confidence: 49%

Fat drops in wrist tendon sheaths on MRI in conjunction with a radius fracture

Verhagen

Chesaru

2016

Skeletal Radiol

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A case is presented in which fat drops are seen on MRI inside extensor compartment 2 and 3, in conjunction with a radius fracture. The occurrence of traumatic tendon sheath fat-fluid levels has been sparsely reported on CT and MR imaging. This case is the first report of post-traumatic tendon sheath fat drops. Although the clinical relevance of tendon sheath fat drops seems to be limited, it is important to detect and correctly diagnose these fat drops in order to provide an accurate and complete radiologic report.

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Section: Discussionsupporting

confidence: 49%

Fat drops in wrist tendon sheaths on MRI in conjunction with a radius fracture

Verhagen

Chesaru

2016

Skeletal Radiol

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“…It extends proximally for 1 to 2 cm from the extensor retinaculum and distally crosses the second osseofibrous tunnel (Figure 6). At this level, there is usually a more or less extensive communication with the sheath of the second tunnel 9 . The sheath of the third tunnel then follows the long extensor tendon of the thumb for most of its extension.…”

Section: Discussionmentioning

confidence: 99%

“…At this level, there is usually a more or less extensive communication with the sheath of the second tunnel. 9 The sheath of the third tunnel then follows the long extensor tendon of the thumb for most of its extension.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 1131 consecutive wrist sonographic examinations were performed over a 5-year period by our department using a linear multifrequency probe (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) MHz) on an iU22 ultrasound system (Philips Healthcare, Eindhoven, the Netherlands), an Acuson S2000 system (Siemens AG, Erlangen, Germany), a LOGIQ E9 system (GE Healthcare, Waukesha, WI), and an Aplio 500 system (Toshiba Corporation, Tokyo, Japan). The high number of examinations was due to requests for imaging confirmation of clinical diagnoses coming from hand surgeons who work in our institution and a lack of trained specialists in nearby smaller centers.…”

Section: Methodsmentioning

confidence: 99%

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Musculoskeletal Sonography for Evaluation of Anatomic Variations of Extensor Tendon Synovial Sheaths in the Wrist

Draghi

Bortolotto

Draghi

et al. 2015

J of Ultrasound Medicine

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he wrist extensor tendons run through 6 osseofibrous tunnels surrounded by synovial sheaths, which prevent friction from the tendons and the surrounding structures ( Figure 1 and Video 1). 1,2 The synovial sheaths are made up of 2 layers: a parietal layer, which is in contact with the structures surrounding the tendons, and a visceral layer, which is in contact with the tendons themselves. Various types of mesotendons, which cross the synovial sheaths and contain vessels and nerves, connect the tendons with the surrounding structures. The sheaths cannot be assessed by sonography under physiologic conditions, but they become evident when fluid is present within them. Normally, each osseofibrous tunnel has its own synovial sheath. 2 There are, however, many important variations, 3 which are necessary to be aware of before infiltrative ultrasoundguided therapy or surgery is performed. Anatomic variations can influence infiltration or the surgical approach to avoid complications. The purpose of this article is to show anatomic variations of extensor tendon synovial sheaths in the wrist. ORIGINAL RESEARCHObjectives-The purpose of this article is to show the anatomic variations of extensor tendon synovial sheaths in the wrist.Methods-Videos from 157 patients that were available in the electronic database were reviewed. Sonography showed involvement of 186 tendon sheaths.Results-We describe our center's experience with most tendon variants described in the literature and show the sonographic appearance of the most frequent ones.Conclusions-Sonography is an accepted, safe, and efficient method for evaluating conditions characterized by effusion into the synovial sheaths of the wrist extensor tendons. Knowledge of anatomy and anatomic abnormalities of these sheaths is essential for diagnosis and for correct ultrasound-guided injection therapy or, less frequently, planning a surgical approach.

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“…Normal communication between the third or fourth compartment and the radiocarpal joint is not described. A normal foramen exists, however, in the vast majority of people between the sheaths of the EPL and the ECRL and ECRB at the wrist [9][10][11], which may explain the small amount of fat seen within the second compartment.…”

Section: Discussionmentioning

confidence: 99%

Part II - Dorsal wrist pain and swelling post trauma 2

et al. 2013

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DiagnosisTraumatic lipohaematoma of the extensor tendon sheaths (compartments 2-4) post distal radial fracture. DiscussionIn the same way that identification of a lipohaemarthrosis alerts the reading radiologist to the presence of an intraarticular fracture, the visualisation of a lipohaematoma of the tendon sheath after trauma may herald the presence of fracture extending into an osseous groove for a tendon. It also indicates injury to the tendon sheath, and raises the possibility of associated tendon injury, which may warrant further assessment of the affected tendon with magnetic resonance imaging.A 29-year-old man presented post cyclist vs car accident. CT showed a comminuted distal radial fracture. As shown in Fig. 3 of the case presentation, a fracture line cleaved completely through the base of Lister's tubercle (larger arrow) with disruption of the floor of the fourth compartment by an acute angled sharp fracture fragment (smaller arrow). Fracture lines extended into the grooves for extensor pollicis longus (3rd extensor compartment) and extensor digitorum (4th extensor compartment). A separate fracture passed into the grooves for extensor carpi radialis longus and brevis (2nd extensor compartment). The edges of the fracture fragments were sharply angulated and disrupted the osseous grooves for the 3rd and 4th compartment tendons. The medullary cavity of the distal radius appeared open to the tendon sheaths of both the 3rd and 4th extensor compartments. An oblique sagittal fracture line was also seen extending from the volar surface of the radius through the articular surface. A small lipohaemarthrosis of the radiocarpal joint was present. Further distally, within the tendon sheaths of the second, third and fourth extensor compartments prominent fat-fluid levels within the tendon sheaths were seen, accounting for the gross soft tissue swelling seen on the radiograph. The lipohaematoma was most voluminous within the distal third and fourth compartment sheaths, and comparatively small in the second compartment sheaths. The average Hounsfield Unit density of the upper (and, by volume, larger) layer within the tendon sheaths was approximately −90, consistent with the presence of fat.Magnetic resonance imaging obtained 4 days after the injury showed fat-fluid layers within the non-dependent aspect of the sheaths of the second, third and fourth compartments. A layer of high T1 signal within the nondependent aspect of the sheaths (part 1 figure 2 -arrow), which completely saturated on T2 fat suppression and corresponded to the position of the −90 HU density material seen on the CT, was present, confirming the presence of fat. The distal radial fracture is also evident on this image. There was focal irregular high T2 signal seen along the deep radial side surface of tendons of the extensor digitorum and extensor pollicis longus adjacent to the sharp fracture edges, consistent with tendon abrasion, but no frank split or rupture was seen. The dependent portion of the lipohaematoma showed signal characteristics con...

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Communicating Foramen Between the Tendon Sheaths of the Extensor Carpi Radialis Brevis and Extensor Pollicis Longus Muscles: Imaging of Cadavers and Patients

Cited by 22 publications

References 10 publications

Fat drops in wrist tendon sheaths on MRI in conjunction with a radius fracture

Fat drops in wrist tendon sheaths on MRI in conjunction with a radius fracture

Musculoskeletal Sonography for Evaluation of Anatomic Variations of Extensor Tendon Synovial Sheaths in the Wrist

Part II - Dorsal wrist pain and swelling post trauma 2

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