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. He denied 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. He had 4/5 strength in wrist flexion and ulnar deviation. Type of Probe Used: L8 - 18i hockey stick transducer Unlabeled long axis view of the flexor carpi ulnaris insertion Unlabeled long axis view of the flexor carpi ulnaris tendon at its insertion onto the pisiform. Labeled long axis view of the flexor carpi ulnaris insertion Labeled long axis view of the flexor carpi ulnaris tendon (arrows) at its insertion onto the pisiform. Region of calcification encircled. Unlabeled short axis view of the flexor carpi ulnaris insertion Unlabeled short axis view of the flexor carpi ulnaris tendon at its insertion onto the pisiform. Labeled short axis view of the flexor carpi ulnaris insertion 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 long axis view of the flexor carpi ulnaris calcification measurement Unlabeled long axis view of the flexor carpi ulnaris calcification measurement. Measuring approximately 0.59cm in length and 0.13cm in thickness. Unlabeled short axis view of the flexor carpi ulnaris calcification measurement Unlabeled short axis view of the flexor carpi ulnaris calcification measurement, measuring approximately 0.68cm by 0.19cm. 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. The calcification measures approximately 0.59 cm x 0.68 cm x 0.19 cm. Teaching Pearl: Flexor carpi ulnaris pathology is one of several potential causes of ulnar-sided wrist pain, and calcific tendinopathy at the pisiform insertion can be missed if the scan does not include the FCU tendon. Ultrasound can show hyperechoic calcific foci within or adjacent to the tendon, often with posterior acoustic shadowing and focal tenderness. It's important to evaluate nearby structures that can cause similar pain patterns as well such as the pisotriquetral joint, Guyon's canal, ulnar nerve and artery, triangular fibrocartilage region, and adjacent flexor tendons. See here for more representative examples: https://pmc.ncbi.nlm.nih.gov/articles/PMC8590569/ References: 1. Ahuja A, Lawande M, Daftary AR. Role of radiographs and ultrasound in diagnosing calcific tendinitis and periarthritis in the wrist and hand with ultrasound-guided barbotage as management tool. Indian J Radiol Imaging. 2021;31(3):605-610. doi:10.1055/s-0041-1736397 2. Ghanaati H, Makki Z, Mardpour S. Acute calcific tendinitis of flexor carpi ulnaris: a big mimicker and unusual cause of wrist pain with a pictorial review. Iran J Radiol. 2020;17(3):e97424. doi:10.5812/iranjradiol.97424 3. Flores DV, Murray T, Jacobson JA. Diagnostic and interventional US of the wrist and hand: quadrant-based approach. Radiographics. 2023;43(8):e230046. doi:10.1148/rg.230046
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Authors, Editors, Case Information

Unlabeled long axis view of the flexor carpi ulnaris insertion

Labeled long axis view of the flexor carpi ulnaris insertion

Unlabeled short axis view of the flexor carpi ulnaris insertion

Labeled short axis view of the flexor carpi ulnaris insertion

Unlabeled long axis view of the flexor carpi ulnaris calcification measurement

Unlabeled short axis view of the flexor carpi ulnaris calcification measurement

Interpretation

UPCOMING EVENTS

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