8/12/2019 Flexor Carpi Radialis Tendinitis - Hand - Orthobullets

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Updated: 8/23/2017
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Flexor Carpi Radialis Tendinitis

 Hand


Colin Woon David Abbasi

TOPIC EVIDENCE
Review Topic 1

Introduction

A condition characterized by inflammation of the FCR tendon sheath

Demographics
incidence
uncommon
risk factors
repetitive wrist flexion
golfers and racquet sports
manual labor
Pathoanatomy
primary stenosing tenosynovitis within the fibroosseous tunnel (see Anatomy)
secondary tendinitis associated with
scaphoid fracture
scaphoid cysts
distal radius fracture
scaphoid-trapezium-trapezoid joint arthritis
thumb CMC joint arthritis
Prognosis
prognosis is poor if the following are present
history of overuse
worker's compensation
failure to respond to local injection
long duration of symptoms

Anatomy

Flexor carpi radialis musculotendinous unit

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FCR muscle
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FCR tendon
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enveloped by sheath from musculotendinous origin to trapezium

no fibrous sheath distal to trapezium
enters fibroosseous tunnel at the proximal border of the trapezium
 Hand boundaries 

radial = body of the trapezium

palmar = trapezial crest, transverse carpal ligament
ulnar = retinacular septum from transverse carpal ligament (separates
FCR from carpal tunnel)
dorsal = reflection of retinacular septum on trapezium body
space
within the tunnel
the FCR tendon occupies 90% of space
is in direct contact with the roughened surface of the trapezium
more prone to constriction, tendinitis, attrition, rupture
proximal to the tunnel
the FCR tendon occupies 50-65% of space within FCR sheath
proximal to the tunnel
less prone to constriction
but more prone to mechanical irritation from osteophytes
insertion
small slip (1-2mm) inserts into trapezial crest
80% of remaining tendon inserts into 2nd metacarpal
20% of remaining tendon inserts into 3rd metacarpal

Presentation

Symptoms
volar radial aspect of the wrist
Physical exam
tenderness over volar radial forearm along FCR tendon at distal wrist flexion crease
provocative test
resisted wrist flexion triggers pain
resisted radial wrist deviation triggers pain

Imaging

Radiographs
findings
in primary tendinitis, radiographs are unremarkable
in secondary tendinitis, the following may be present
healed scaphoid fracture
healed distal radius fracture
exostosis or arthritis of scaphotrapezoid joint or thumb CMC
MRI
views
best seen on T2
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8/12/2019 Flexor Carpi Radialis Tendinitis - Hand - Orthobullets

findings
 
increased SEARCH
signal around FCR sheath on T2 image
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may find associated conditions in secondary tendinitis

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ganglion
scaphoid cyst

 Studies
Hand
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Diagnostic injection
injection of local anesthetic along FCR sheath relieves symptoms

Differentials

Thumb CMC arthritis

Scaphoid cyst
Ganglion
De Quervain's tenosynovitis

Treatment

Nonoperative
immobilization, NSAIDS, steroid injection
indications
first line of treatment
technique
direct steroid injection in proximity, but not into tendon
outcomes
usually effective for primary tendinitis
unsuccessful in secondary tendinitis if other lesions are present (e.g.
osteophytes)
Operative
surgical release of FCR tendon sheath
indications
rarely needed but can be effective in recalcitrant cases

Surgical Technique

Surgical release of FCR tendon sheath

approach
volar longitudinal incision starting proximal to the wrist crease, extending over
proximal thenar eminence
care taken to avoid
palmar cutaneous branch of median nerve
lateral antebrachial cutaneous nerve
superficial sensory radial nerve
technique
elevate and reflect thenar muscles radially
expose FCR sheath

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open FCR sheath proximally in the distal forearm, and extend to the trapezial
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at the trapezial crest, the tendon enters the FCR tunnel

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at this point, incise the sheath along the ulnar margin, taking care not to injure the
tendon
mobilize tendon from trapezoidal groove (releasing trapezial insertion)
 Hand


Complications

Complications of disease
FCR attrition and rupture
Complications of surgical release
cutaneous nerve injury
palmar cutaneous branch of median nerve
lateral antebrachial cutaneous nerve
superficial sensory radial nerve
injury to deep palmar arch
injury to FPL tendon (lies superficial to FCR tendon)
injury to FCR tendon within the tunnel
decompression is easy proximal to the tunnel (incision of FCR sheath)
within FCR fibroosseous tunnel, take care to avoid cutting FCR tendon

Please rate topic.  Average 4.8 of 11 Ratings

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Essential Core Tested Community All

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80%
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Cost Effectiveness (more →)

60%
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40%

20%

0%
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Key

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