Tendon Anatomy and Tendon Disorders of the Wrist

Abstract

Background

Wrist pain is common and can be attributed to tendon pathologies.

Methods

This review aims to give a structured review of tendon anatomy, discuss anatomical pitfalls, and provide an overview of typical tendon pathologies of the wrist based on the current literature.

Results

Typical tendon pathologies of the wrist include de Quervain tenosynovitis, proximal and distal intersection syndrome, extensor and flexor pollicis longus tendon ruptures, and extensor carpi ulnaris subsheath injury. Typical pitfalls are multiple bundles of the abductor pollicis longus tendon or the centrally increased signal of the extensor carpi ulnaris tendon.

Conclusion

Both ultrasound and MRI are appropriate modalities for assessing the tendons of the wrist. Knowledge of normal anatomy, variants, pathologies, as well as appropriate imaging is crucial to determine the diagnosis.

Key Points

• Multiple tendon bundles of the abductor pollicis longus are a common anatomical feature and should not be mistaken for tendon splitting.

• An anatomical pitfall resembles the frequently found centrally increased signal of the extensor carpi ulnaris tendon caused by fibrovascular tissue.

• In order to visualize the diagnosis of a proximal intersection syndrome, the MR scan field needs to include the area approximately 4 to 8 cm proximal to Lister’s tubercle.

• The tendons of the thumb, i.e., extensor and flexor pollicis longus, are most commonly torn after distal radial fracture (EPL) and osseous hardware fixation (FPL).

Citation Format

• Marth T, Grob NA, Jacobson JA et al. Tendon Anatomy and Tendon Disorders of the Wrist. Rofo 2025; 197: 1148–1161

Zusammenfassung

Hintergrund

Handgelenkschmerzen sind häufig und können auf Pathologien der Sehnen beruhen.

Methoden

Dieser Review soll eine strukturierte Übersicht der Sehnenanatomie geben, Fallstricke diskutieren und einen Überblick über typische Sehnenpathologien des Handgelenks verschaffen, basierend auf der aktuellen Literatur.

Ergebnisse

Typische Sehnenpathologien des Handgelenks sind eine de Quervain Tendovaginitis, ein proximales und distales Intersektionssyndrom, Rupturen der extensor und flexor pollicis longus-Sehnen und Verletzungen der Subscheide der extensor carpi ulnaris-Sehne. Typische Fallstricke sind multiple Sehnenbündel der abductor pollicis longus-Sehne oder ein zentral erhöhtes Signal der extensor carpi ulnaris-Sehne.

Schlussfolgerung

Ultraschall und MRT sind beides geeignete bildgebende Modalitäten zur Untersuchung der Handgelenksehnen. Kenntnis der normalen Anatomie, Varianten, Pathologien sowie der angebrachten Bildgebung ist entscheidend, um die Diagnose zu stellen.

Kernaussagen

• Multiple Sehnenbündel der abductor pollicis longus-Sehne sind ein häufiges anatomisches Merkmal und sollten nicht als Aufspaltung der Sehne fehlinterpretiert werden.

• Ein anatomischer Fallstrick ist das häufig erhöhte zentrale Signal der extensor carpi ulnaris-Sehne, welches durch fibrovaskuläres Gewebe hervorgerufen wird.

• Um ein proximales Intersektionssyndrom darzustellen, muss der MR-Scanbereich 4 bis 8 cm proximal des Lister Tuberkels mit einbeziehen.

• Daumensehnen sind häufig rupturiert nach distaler Radiusfraktur (extensor pollicis longus) und osteosynthetischer Versorgung (flexor pollicis longus).

Keywords

wrist - tendons - MR-imaging - ultrasound - intersection syndrome - De Quervain tenosynovitis

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