2004 Texas Radiological Society UNKNOWN CASES MR Imaging

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2004 Texas Radiological SocietyUNKNOWN CASESMR
Imaging

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Wilford Hall Medical Center
• San Antonio, TX

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MR IMAGING

• Painful mass at distal forearm
• Known scapholunate advanced collapse (SLAC) wrist
  and TFCC tear

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(No Transcript)
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2004 Texas Radiological SocietyDiagnosis forMR
Imaging Case

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Wilford Hall Medical Center
• San Antonio, TX

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Intersection Syndrome

• 1841 first description by Velpeau
• Overuse
• A/w athletic activ (racket sports, rowing,
  canoing, skiing)
• Friction between muscle bellies of 1st extensor
  comp tendons and adj 2nd comp tendons (Howard)
• Pain/swelling proximal to Lister tubercle of
  distal radius
• Main diff dx De Quervains tenosynovitis

Howard NJ. Peritendinitis crepitans. J Bone Joint
Surg Br 193719447-459. Costa CR et al. MRI
features of intersection syndrome of the forearm.
AJR 20031811245-1249.
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Cross-over point--lateral pollicus muscles (EPB
APL) pass over wrist extensors (ECRL
ECRB) Possible associated tendinitis of extensor
tendons Hypertrophy lateral pollicus muscle
bellies may predispose
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Intersection Syndrome

• MR
• Peritendinous edema around 1st / 2nd extensor
  compartment tendons, extending proximally from
  crossover ptmost characteristic finding
• Chronic cases may be subtle and not show signif
  MR findings, likely reflecting development of
  stenosing tenosynovitis
• Tx
• Conserv 1st line (NSAIDS, splinting)
• Surg-tenosynovectomy/fasciotomy of abductor
  pollicis longus

Costa CR et al. MRI features of intersection
syndrome of the forearm. AJR 20031811245-1249.
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DDX De Quervains Tenosynovitis
Fluid distending tendon sheath, surrounding
thickened tendons of 1st extensor compartment
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2004 Texas Radiological SocietyUNKNOWN CASES

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Wilford Hall Medical Center
• San Antonio, TX

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