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Extensor Retinaculum of the Wrist: Sonographic Characterization and Pseudotenosynovitis Appearance

Brian L. Robertson1, David A. Jamadar1, Jon A. Jacobson1, Monica Kalume-Brigido1, Elaine M. Caoili1, Zvi Margaliot2 and Michel O. De Maeseneer1,3

1 Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr., TC2910, Ann Arbor, MI 48109.
2 Division of Plastic Surgery, Department of Surgery, Trillium Health Centre, Mississauga, ON, Canada.
3 Present address: Division of Radiologic Sciences, Wake Forest University, Winston-Salem, NC 27157-1088.


Figure 1
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  		Fig. 1 —Illustration of dorsal wrist shows extensor retinaculum (blue) extending obliquely across dorsal wrist. Note extensor digitorum tendons (red) and tendon sheaths (yellow).

 

Figure 2
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  		Fig. 2 —Photograph of dissected right dorsal wrist of elderly male cadaver shows extensor retinaculum (arrowheads) superficial to extensor tendons (T). Left is ulnar, and right is radial.

 

Figure 3
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  		Fig. 3A —37-year-old woman with normal extensor retinaculum. Sonograms along long axis of extensor retinaculum (A) and along short axis of extensor retinaculum (B) show normal subtle compact fibrillar extensor retinaculum (arrows) to be relatively hypoechoic compared with adjacent extensor digitorum tendons (ED). Note radius (R) in B, lunate (L) in A and B, capitate (C) in B, and scaphoid (S) in A; distal is to right in B.

 

Figure 4
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  		Fig. 3B —37-year-old woman with normal extensor retinaculum. Sonograms along long axis of extensor retinaculum (A) and along short axis of extensor retinaculum (B) show normal subtle compact fibrillar extensor retinaculum (arrows) to be relatively hypoechoic compared with adjacent extensor digitorum tendons (ED). Note radius (R) in B, lunate (L) in A and B, capitate (C) in B, and scaphoid (S) in A; distal is to right in B.

 

Figure 5
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  		Fig. 4 —50-year-old woman with normal extensor retinaculum. Sonogram along short axis of extensor retinaculum shows its characteristic fusiform thickening and location (arrows). Note hypoechoic appearance relative to extensor digitorum tendons (ED), although internal echoes are still visible. Note radius (R), lunate (L), and capitate (C) bones; distal is to right.

 

Figure 6
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  		Fig. 5A —37-year-old man with normal extensor retinaculum. Sonograms show effect of angling transducer between relatively perpendicular (A) to retinaculum (arrows, A) and at angle (B) to retinaculum (arrows, B). Retinaculum appears more hypoechoic when beam is at angle. Note extensor digitorum tendons (ED) and radius (R), lunate (L), and capitate (C) bones; distal is to right.

 

Figure 7
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  		Fig. 5B —37-year-old man with normal extensor retinaculum. Sonograms show effect of angling transducer between relatively perpendicular (A) to retinaculum (arrows, A) and at angle (B) to retinaculum (arrows, B). Retinaculum appears more hypoechoic when beam is at angle. Note extensor digitorum tendons (ED) and radius (R), lunate (L), and capitate (C) bones; distal is to right.

 

Figure 8
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  		Fig. 6 —48-year-old man with 19-year history of psoriasis and asymptomatic dorsal wrist. Sonogram shows retinaculum retains fusiform shape (arrows), but flow adjacent to retinaculum is increased and flow around extensor digitorum tendons (ED) is increased. Note radius (R). Distal is to right.

 

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