ARRS 2022 Abstracts

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1293. Tenosynovitis of Wrist: Does Compartment Distribution Aid in Determining the Etiology of Tenosynovitis
Authors * Denotes Presenting Author
  1. Joshua Mehr; UT Southwestern Radiology
  2. Raghu Ratakonda; UT Southwestern Radiology
  3. Bayan Mogharrabi *; UT Southwestern Radiology
  4. Avneesh Chhabra; UT Southwestern Radiology
Objective:
Wrist pain disorders affect roughly 10% of the general population with tenosynovitis being an important etiopathogenesis for wrist pain and dysfunction. We aim was to conduct a systematic evaluation of wrist MRI scans from a large tertiary care institution to determine the frequency of tenosynovitis, its distribution and correlation with the final clinical diagnosis.

Materials and Methods:
This was a cross-sectional retrospective auditing and repeat interpretation of wrist MRIs at our institution. A consecutive series of 614 wrist MRIs from 2015-2020 were audited, and two medical students conducted chart reviews for the final clinical diagnoses. The scans were re-evaluated by a senior MSK radiologist and a MSK fellow for confirmation of tenosynovitis, and compartment distributions were recorded. The five tendon compartments evaluated included: first extensor; sixth extensor; multiple/multifocal extensors; flexor compartments including flexor digitorum profundus/superficialis and flexor carpi radialis; and finally, flexor pollicis longus compartment. The final clinical diagnostic categories included: chronic overuse; Dequervain’s tenosynovitis; trauma; infection; inflammation; TFCC injury; and nonspecific (idiopathic). Pairwise comparisons were made using Fisher’s exact test and p-values were adjusted using Sidak method for multiple comparisons.

Results:
There were 216/614 (35%) patients who demonstrated tenosynovitis (14/216 in both wrists, 112/216 in the right and 90/216 in the left). There were 131 female patients and 85 male patients with ages ranging from 18 to 84 years old. The final diagnoses were: chronic overuse (32/216); Dequervain’s (22/216); iatrogenic or trauma (72/216); infection (11/216); inflammation (52/216); TFCC injury (5/216); and non-specific (22/216), respectively. The compartments affected were: first extensor compartment (51/216); sixth extensor compartment (120/216); multiple/multifocal extensors compartment (34/216); flexor compartments (104/216); and flexor pollicis longus (54/216). The first extensor compartment correlated with a final diagnosis of Dequervain’s tenosynovitis (p = 0.00). Flexor compartment tenosynovitis correlated with inflammatory etiologies (p = 0.048). No significant correlations were found with respect to other compartments or disease categories (p > .05).

Conclusion:
Wrist tenosynovitis shows a wide spectrum of distribution with a significant association of flexor compartment involvement in inflammatory conditions and first extensor compartment in Dequervain’s tenosynovitis. Results from this systematic evaluation can aid in rendering timely and accurate diagnosis by the radiologist based on the pattern of distribution of tenosynovitis and for prompt management.