Presentation
Chronic wrist pain
Patient Data
The distal part of the extensor digitorum tendon is thickened and shows cystic changes within its substance with partial fiber interruption. The tendon sheath is distended with fluid.
The tendon sheath of the extensor digitorum is distended with fluid displaying intermediate signal intensity in T1 WIs and high signal intensity in T2 and STIR WIs. Cystic changes are seen within the substance of the extensor digitorum fibers displaying intermediate to high signal intensity in T1 WIs and high signal intensity in T2 and STIR images. These findings are suggestive of the high proteinaceous content of the fluid.
Annotated images describing the correlation between the cystic changes seen by ultrasound and the high proteinaceous fluid signal in magnetic resonance imaging:
intermediate to high signal intensity in T1 (yellow arrow)
high signal intensity in T2 (red arrow)
high signal intensity in STIR (blue arrow)
cystic changes within the substance of the tendon by ultrasound in (TS) and (LS) views (green arrows)
Case Discussion
Intratendinous ganglion cysts are relatively uncommon. Their etiology is mostly related to mucous degeneration due to repetitive trauma. Complicated intratendinous ganglion cysts have a higher signal on T1 WIs due to their high proteinaceous content. The presence of cystic degeneration within the substance of the tendon reflects mucoid changes. Mucoid degeneration commonly affects the extensor tendons of the hand of females in their 5th and 6th decades of life.
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