PMC6180899_01
Flexion deformity of the right middle and ring fingers with erosions of the right index and ring finger carpometacarpal joints and metacarpophalangeal joints) evident (arrows).
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PMC6180899_01_bjrcr.20150404.g001.jpg
fig1
(a) Long-axis power Doppler ultrasound image demonstrating hypoechoic nodules (arrows) and tenosynovitis extending along the flexor tendon sheaths (dashed lines) and overlying the radius (solid line). (b) Long-axis ultrasound demonstrating synovial hypertrophy and hypoechoic nodules (arrows) over the dorsal carpus (dashed arrows).
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fig2
There was marked tendinosis with associated tenosynovitis affecting the middle and ring finger flexor tendons (Figure 2a). There was synovial hypertrophy at the carpus (Figure 2b) and MCPJs with minor increase in vascularity.
(a) Short tau inversion-recovery and T
1 weighted axial images demonstrating extensive peritendinous soft tissue thickening consistent with florid tenosynovitis affecting the extensor and flexor compartments with mild fluid distension (arrows) and peritendinous low signal (asterisks). (b) Coronal proton density spectral attenuated inversion-recovery and gradient echo sequences demonstrating low signal synovitis with areas of blooming artefact (asterisks) surrounding the wrist, carpus, ring and middle finger MCPJs. (c) Serial coronal gradient echo images demonstrating siderotic lobulated synovial proliferation at the level of the wrist and carpus invading into and tracking distally along the flexor tendons to involve the index, middle and ring finger MCPJs. There are multiple intra-articular and peritendinous foci of low signal with foci of susceptibility artefact consistent with haemosiderin deposition. MCPJs, metacarpophalangeal joints.
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fig3
T 1 weighted images with areas of blooming artefact in addition to minor fluid distension (Figure 3a). There was also involvement of the flexor tendons at the level of the carpus, again with low signal surrounding the tendons (Figure 3a). Tenosynovial thickening of the flexor compartment resulted in flattening and compression of the median nerve at the level of the carpal tunnel. Hypointense lobulated synovitis was seen at the wrist and carpus and also at the index, middle and ring finger MCPJs and thumb interphalangeal joint (Figure 3b,c).