Surgical Management of the Trapezium Canal Syndrome: An Uncommon Presentation of Tenosynovitis of Flexor Carpi Radialis

Abstract

Flexor carpi radialis (FCR) tenosynovitis is a condition characterized by pain over the volar radial wrist caused by inflammation of the FCR tendon sheath. It is an uncommon and often unrecognized pathology that could be misleading from a diagnostic and therapeutic point of view. Treatment usually involves immobilization, nonsteroidal anti-inflammatory drugs, and injections. In refractory cases, operative release of the FCR tendon sheath may be indicated. In this article, we report our experience in treating FCR tenosynovitis by surgically decompressing the trapezium canal, through which the tendon runs, at the wrist. In our experience, this surgical technique allows a good functional recovery with the resolution of painful symptoms without notable complications.

Non-surgical management of Trapezium canal syndrome an uncommon presentation of Flexor carpi radialis tenosynovitis

“…5 Radiological assessment of FCR tendonitis may show scapho-trapezium-trapezoid morphological alteration, osteoarthritis, and bone erosions. 1 Allred DW et al and Verellen K et al, 13,14 FCR endinopathy is an MRI obtained finding that may be symptomatic in variable cases. 13,14 Ultrasonography is mainly operator dependent, however, a well-experience operator can diagnose FCR tendonitis.…”

“…It is attributed to a process of inflammation, which is related to the sheath of the FCR tendon. 1,5 However, FCR tendonitis could be attributed to mechanical narrowing of the osteofibrous gliding tunnel engulfing the tendon sheath. It is usually due to traumatic phenomenon.…”

“…6 FCR tendonitis is a middle-aged condition which tends to affect the dominant hand, and known to be underdiagnosed despite the fact of high occurrence among sports and jobs with repetitive or overuse wrist activities. 1,2,7,8 The FCR tendon runs within its own tunnel through a groove in the trapezium, which is separated by the deep portion of the transverse carpal ligament from the carpal tunnel. 9 The FCR tendon then inserts to the base of the second metacarpal after it enters the fibro-osseous tunnel.…”

“…13,14 Ultrasonography is mainly operator dependent, however, a well-experience operator can diagnose FCR tendonitis. 1 As any tendinopathy, conservative management as such as a course of physiotherapy strengthening exercises, rest with splinting, stretching and oral antiinflammatory medications are the initial treatment options for FCR tendinitis patients. 2,5,15 Corticosteroid injection in the tendon sheath with local anesthesia may reduce the pain and help differentiating FCR tendonitis from other diseases.…”

“…Flexor carpi radialis (FCR) tendonitis is described as a pain at the palmar aspect of the radial wrist, attributed to a process of inflammation. 1 Repetitive flexion demanding sports at the wrist joint such as racquet, volleyball and basketball players showed an increased likelihood for this condition occurrence. 2 The diagnosis of FCR tendonitis is appreciated clinically based on presence of pain, erythema, warmth and swelling of the palmar side of the wrist.…”