Tendons and Tendon Sheaths of the Hand - An Update on MRI

Area of Science:

• Orthopedics and Sports Medicine
• Radiology
• Rheumatology

Background:

• Tendons and tendon sheaths in the hand are anatomically positioned for close interaction and are susceptible to inflammation.
• The narrow spaces within the hand make tendons and their sheaths vulnerable to mechanical stress, systemic diseases, and infections.

Approach:

• This review details various tendon and tendon sheath pathologies affecting the hand.
• Diagnostic findings are illustrated using high-resolution magnetic resonance imaging (MRI).
• The review correlates MRI findings with current scientific literature on hand tendon disorders.

Key Points:

• Etiologies of tendon and tendon sheath diseases include mechanical, degenerative, metabolic, inflammatory, and infectious factors.
• Anatomical structures like fibrous tunnels and bony prominences predispose to mechanical tendon irritation at characteristic hand sites.
• Stenosing tenosynovitis (e.g., trigger finger, de Quervain disease) affects the fibrous layer, while proliferative tenosynovitis (e.g., rheumatoid arthritis) involves the synovial layer.

Conclusions:

• Overuse can lead to tendinosis and stenosis of retinacula and annular ligaments.
• Proliferative tenosynovitis affects the synovial layer, potentially infiltrating tendons, with pyogenic tenosynovitis favoring flexor compartments.
• Accurate diagnosis of hand tendon and sheath pathology necessitates high-resolution MRI due to the confined anatomical spaces.