Flexor Carpi Ulnaris Calcific Tendinopathy

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Flexor Carpi Ulnaris Calcific Tendinopathy

Authors, Editors, Case Information Author: Jacob Laperche, MD Affiliation: UConn Family Medicine Residency at Manchester Memorial Hospital Co Author(s): Alex Pomerantz, MD, MPP Boston University Ryan Center for Sports Medicine Nathan Cardoos, MD, CAQSM, RMSK Boston University Ryan Center for Sports Medicine Senior Editor: Michael Krill, MD, ATC Clinical Vignette: A 33-year-old right-hand-dominant male squash player presented for atraumatic worsening left wrist pain and loss of range of motion over the previous 2 months. Patient denies previous injury or pain to the wrist. Physical exam of the left wrist demonstrated significant tenderness about the distal flexor carpi ulnaris tendon, wrist range of motion from 80 degrees of flexion through 0 degrees of extension. 4/5 strength in flexion and ulnar deviation. Type of Probe Used: L8 - 18i hockey stick transducer #1 - Image Labeled long axis view of the flexor carpi ulnaris tendon with measures of the calcification, 0.59cm in length and 0.13cm in thickness. #2 - Image Labeled short axis view of the flexor carpi ulnaris tendon with measures of the calcification, 0.68cm by 0.19cm. Labeled short axis view of the flexor carpi ulnaris Labeled short axis view of the flexor carpi ulnaris tendon (arrows) at its insertion onto the pisiform. Calcification seen as speckling within the tendon. Unlabeled short axis view of the flexor carpi ulnaris Unlabeled short axis view of the flexor carpi ulnaris tendon at its insertion onto the pisiform. Labeled long axis view of the flexor carpi ulnaris Labeled long axis view of the flexor carpi ulnaris tendon (arrows) at its insertion onto the pisiform. Region of calcification encircled. Unlabeled long axis view of the flexor carpi ulnaris Unlabeled long axis view of the flexor carpi ulnaris tendon at its insertion onto the pisiform. Interpretation Image Interpretation: The distal insertion of the flexor carpi ulnaris (FCU) tendon demonstrated significant intrasubstance calcification about the insertion site at the pisiform suggestive of FCU calcific tendinopathy. Teaching Pearl: Flexor carpi ulnaris pathology is one of many potential pain sources to the ulnar side of the wrist. Calcification within tendons of the hand is rare and accounts for less than 3% of whole-body tendinous calcifications, however; the FCU tendon is the most frequently affected tendon in the hand and wrist.[1] Flexor carpi ulnaris calcific tendinopathy should be considered when clicking and mechanical symptoms are present in conjunction with ulnar wrist pain. Ultrasound may be an accurate diagnostic modality although more data is needed to clarify its sensitivity and specificity. See here for more representative examples: https://pmc.ncbi.nlm.nih.gov/articles/PMC8590569/ [1]https://pmc.ncbi.nlm.nih.gov/articles/PMC9826684/
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Phone: 913.327.1415

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Authors, Editors, Case Information

#1 - Image

#2 - Image

Labeled short axis view of the flexor carpi ulnaris

Unlabeled short axis view of the flexor carpi ulnaris

Labeled long axis view of the flexor carpi ulnaris

Unlabeled long axis view of the flexor carpi ulnaris

Interpretation

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