Orthopedic hardware impingement - 1st extensor compartment of the wrist
Presentation
Intramedullary nailing across the radius midshaft fracture 3 months back. Complaining of painful and restricted thumb movements. Ultrasound was requested to evaluate the 1st extensor compartment of the wrist.
Patient Data
Both tendons of the 1st extensor compartment of the wrist show continuity. However, the extensor pollicis brevis tendon is thicker than the abductor pollicis longus tendon. The extensor pollicis brevis tendon is compressed between the radius bone and part of the radius intramedullary nail outside the bone. The abductor pollicis longus tendon passes over the radius nail. There is no tenosynovitis. There is a reverberation artifact due to the nail tip.
The transverse plane loop runs from the proximal to the distal direction. An arrow is pointed to the extensor pollicis brevis tendon.
The asymptomatic side was examined for comparison. It shows that the normal abductor pollicis longus tendon is larger than the extensor pollicis brevis in the cross-section.
Case Discussion
A young male had intramedullary nailing for the radius fracture 3 months before the presentation. He had pain and restricted movements of the thumb after the radius nailing. Ultrasound was requested to rule in/ rule out 1st extensor compartment stenosing tenosynovitis/ scar adhesion/ attrition tear due to nail tip.
The ultrasound shows extensor pollicis brevis tendon compression between the radius cortex and the intramedullary nail outside the radius. The tendon is thickened just distal to the compression.
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