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DOI: 10.1055/s-0045-1811588
Lesions of the Extensor Tendons at the Hand
Autor*innen
Abstract
Disorders of the extensor mechanism of the wrist and hand are frequently encountered in clinical practice and observed more commonly than pathologies affecting the flexor system. When unrecognized or inadequately treated, these conditions may lead to substantial functional impairment and suboptimal clinical outcomes. Extensor tendon pathologies encompass a wide range of etiologies, such as repetitive overuse, acute trauma, inflammatory arthropathies, and degenerative tendinopathies. Accurate diagnosis depends on a thorough clinical evaluation, supported by high-resolution imaging. Ultrasound and magnetic resonance imaging are particularly useful for assessing tendon structure, surrounding soft tissues, and dynamic abnormalities. This review offers an updated overview of extensor tendon disorders of the wrist and fingers, focusing on their underlying causes and key imaging findings on magnetic resonance imaging and ultrasound to support an accurate and efficient diagnosis by radiologists.
Publikationsverlauf
Artikel online veröffentlicht:
03. Dezember 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
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References
- 1 Alsaedi OF, Alshahir AA, Alzahim AF. et al. Etiology of traumatic causes of extensor pollicis longus tendon rupture: a systematic review. J Hand Microsurg 2024; 16 (02) 100038
- 2 Meraj S, Gyftopoulos S, Nellans K, Walz D, Brown MS. MRI of the extensor tendons of the wrist. AJR Am J Roentgenol 2017; 209 (05) 1093-1102
- 3 Flores DV, Murray T, Jacobson JA. Diagnostic and interventional US of the wrist and hand: quadrant-based approach. Radiographics 2023; 43 (08) e230046
- 4 Ghazal L, Nabi M, Little C, Teh J. Ultrasound assessment of extensor pollicis longus tendon rupture following distal radius fracture: a sonographic and surgical correlation. J Ultrason 2020; 20 (80) e1-e5
- 5 Roth KM, Blazar PE, Earp BE, Han R, Leung A. Incidence of extensor pollicis longus tendon rupture after nondisplaced distal radius fractures. J Hand Surg Am 2012; 37 (05) 942-947
- 6 Rosskopf AB, Schweizer A. Tendon pathologies of the wrist, hand & fingers (including the surgeon's perspective). In: Shahabpour M. , ed. MRI Wrist & Hand. Horn, Austria: Breitenseher; 2021: 219-235
- 7 Abrego MO, De Cicco FL, Boretto JG, Gallucci GL, De Carli P. Extensor tendons rupture after volar plating of distal radius fracture related to a dorsal radial metaphyseal bone spur. Case Rep Orthop 2018; 2018: 8351205
- 8 Schmitt R, Hesse N, Grunz JP. Tendons and tendon sheaths of the hand: an update on MRI. Rofo 2022; 194 (12) 1307-1321
- 9 Gupta P, Lenchik L, Wuertzer SD, Pacholke DA. High-resolution 3-T MRI of the fingers: review of anatomy and common tendon and ligament injuries. AJR Am J Roentgenol 2015; 204 (03) W314-W323
- 10 Plotkin B, Sampath SC, Sampath SC, Motamedi K. MR imaging and US of the wrist tendons. Radiographics 2016; 36 (06) 1688-1700
- 11 Erickson SJ, Cox IH, Hyde JS, Carrera GF, Strandt JA, Estkowski LD. Effect of tendon orientation on MR imaging signal intensity: a manifestation of the “magic angle” phenomenon. Radiology 1991; 181 (02) 389-392
- 12 Hochman MG, Ramappa AJ, Newman JS, Farraher SW. Imaging of tendons and bursae. In: Weissman BN. ed. Imaging of Arthritis and Metabolic Bone Disease. Philadelphia, PA: WB Saunders; 2009: 196-238
- 13 Haavardsholm EA, Østergaard M, Ejbjerg BJ, Kvan NP, Kvien TK. Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arthritis: reliability in a multireader longitudinal study. Ann Rheum Dis 2007; 66 (09) 1216-1220
- 14 Rosskopf AB, Martinoli C, Sconfienza LM. et al. Sonography of tendon pathology in the hand and wrist. J Ultrason 2021; 21 (87) e306-e317
- 15 Willaume T, Belkaaloul Y, Lucas F, Bierry G. Imaging of sport-related finger injuries. Semin Musculoskelet Radiol 2025; 29 (03) 377-389
- 16 Griffin M, Hindocha S, Jordan D, Saleh M, Khan W. Management of extensor tendon injuries. Open Orthop J 2012; 6: 36-42
- 17 Kleinert HE, Verdan C. Report of the Committee on Tendon Injuries (International Federation of Societies for Surgery of the Hand). J Hand Surg Am 1983; 8 (5 Pt 2): 794-798
- 18 Bellemère P. Treatment of chronic extensor tendons lesions of the fingers. Chir Main 2015; 34 (04) 155-181
- 19 Yoon AP, Chung KC. Management of acute extensor tendon injuries. Clin Plast Surg 2019; 46 (03) 383-391
- 20 De Maeseneer M, Marcelis S, Jager T, Girard C, Gest T, Jamadar D. Spectrum of normal and pathologic findings in the region of the first extensor compartment of the wrist: sonographic findings and correlations with dissections. J Ultrasound Med 2009; 28 (06) 779-786
- 21 Petchprapa CN, Vaswani D. MRI of the fingers: an update. AJR Am J Roentgenol 2019; 213 (03) 534-548
- 22 Rosskopf AB, Taljanovic MS, Sconfienza LM. et al. Pulley, flexor, and extensor tendon injuries of the hand. Semin Musculoskelet Radiol 2021; 25 (02) 203-215
- 23 Cockenpot E, Lefebvre G, Demondion X, Chantelot C, Cotten A. Imaging of sports-related hand and wrist injuries: Sports Imaging Series. Radiology 2016; 279 (03) 674-692
- 24 Aicale R, Tarantino D, Maffulli N. Overuse injuries in sport: a comprehensive overview. J Orthop Surg Res 2018; 13 (01) 309
- 25 Sharma P, Maffulli N. Biology of tendon injury: healing, modeling and remodeling. J Musculoskelet Neuronal Interact 2006; 6 (02) 181-190
- 26 Maffulli N, Cuozzo F, Migliorini F, Oliva F. The tendon unit: biochemical, biomechanical, hormonal influences. J Orthop Surg Res 2023; 18 (01) 311
- 27 Pfirrmann CW, Rosskopf AR. Sonografie des normalen Gewebes. In: Kluge S. ed. Ultraschalldiagnostik der Hand. Berlin, Germany: Springer; 2015: 35-65
- 28 Gitto S, Draghi AG, Draghi F. Sonography of non-neoplastic disorders of the hand and wrist tendons. J Ultrasound Med 2018; 37 (01) 51-68
- 29 Draghi F, Bortolotto C, Draghi AG, Gregoli B. Musculoskeletal sonography for evaluation of anatomic variations of extensor tendon synovial sheaths in the wrist. J Ultrasound Med 2015; 34 (08) 1445-1452
- 30 Kwon BC, Choi SJ, Koh SH, Shin DJ, Baek GH. Sonographic identification of the intracompartmental septum in de Quervain's disease. Clin Orthop Relat Res 2010; 468 (08) 2129-2134
- 31 Cvitanic OA, Henzie GM, Adham M. Communicating foramen between the tendon sheaths of the extensor carpi radialis brevis and extensor pollicis longus muscles: imaging of cadavers and patients. AJR Am J Roentgenol 2007; 189 (05) 1190-1197
- 32 Ilyas AM, Ast M, Schaffer AA, Thoder J. De Quervain tenosynovitis of the wrist. J Am Acad Orthop Surg 2007; 15 (12) 757-764
- 33 McBain B, Rio E, Cook J, Grabinski R, Docking S. Diagnostic accuracy of imaging modalities in the detection of clinically diagnosed de Quervain's syndrome: a systematic review. Skeletal Radiol 2019; 48 (11) 1715-1721
- 34 Draghi F, Bortolotto C. Intersection syndrome: ultrasound imaging. Skeletal Radiol 2014; 43 (03) 283-287
- 35 Montechiarello S, Miozzi F, D'Ambrosio I, Giovagnorio F. The intersection syndrome: ultrasound findings and their diagnostic value. J Ultrasound 2010; 13 (02) 70-73
- 36 Mespreuve M, Waked K, Verstraete K. Imaging findings at the quadrangular joint in carpal boss. J Belg Soc Radiol 2017; 101 (01) 21
- 37 Nevalainen MT, Roedl JB, Morrison WB, Zoga AC. MRI of a painful carpal boss: variations at the extensor carpi radialis brevis insertion and imaging findings in regional traumatic and overuse injuries. Skeletal Radiol 2019; 48 (07) 1079-1085
- 38 Alemohammad AM, Nakamura K, El-Sheneway M, Viegas SF. Incidence of carpal boss and osseous coalition: an anatomic study. J Hand Surg Am 2009; 34 (01) 1-6
- 39 Parellada AJ, Gopez AG, Morrison WB. et al. Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features. Skeletal Radiol 2007; 36 (03) 203-208
- 40 Taljanovic MS, Melville DM, Gimber LH. et al. High-resolution US of rheumatologic diseases. Radiographics 2015; 35 (07) 2026-2048
- 41 Conroy CRD, Vitale MA. Extensor carpi ulnaris instability in athletes—diagnosis and treatment. Oper Tech Sports Med 2016; 24 (02) 139-147
- 42 Campbell D, Campbell R, O'Connor P, Hawkes R. Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management. Br J Sports Med 2013; 47 (17) 1105-1111
- 43 Jeantroux J, Becce F, Guerini H. et al. Athletic injuries of the extensor carpi ulnaris subsheath: MRI findings and utility of gadolinium-enhanced fat-saturated T1-weighted sequences with wrist pronation and supination. Eur Radiol 2011; 21 (01) 160-166
- 44 Ali S, Cunningham R, Amin M, Popoff SN, Mohamed F, Barbe MF. The extensor carpi ulnaris pseudolesion: evaluation with microCT, histology, and MRI. Skeletal Radiol 2015; 44 (12) 1735-1743
- 45 Lee KS, Ablove RH, Singh S, De Smet AA, Haaland B, Fine JP. Ultrasound imaging of normal displacement of the extensor carpi ulnaris tendon within the ulnar groove in 12 forearm-wrist positions. AJR Am J Roentgenol 2009; 193 (03) 651-655
- 46 Montalvan B, Parier J, Brasseur JL, Le Viet D, Drape JL. Extensor carpi ulnaris injuries in tennis players: a study of 28 cases. Br J Sports Med 2006; 40 (05) 424-429 ; discussion 429
- 47 Nevalainen MT, Zoga AC, Rivlin M, Morrison WB, Roedl JB. Extensor carpi ulnaris tendon pathology and ulnar styloid bone marrow edema as diagnostic markers of peripheral triangular fibrocartilage complex tears on wrist MRI: a case-control study. Eur Radiol 2023; 33 (05) 3172-3177
- 48 Fenech M. Boxer's knuckle: sonographic anatomy and assessment of sagittal band tears of the dorsal hood. Australas J Ultrasound Med 2023; 26 (04) 216-229
- 49 Willekens I, Kichouh M, Boulet C, De Maeseneer M, Clarys JP, de Mey J. Ultrasound follow-up of posttraumatic injuries of the sagittal band of the dorsal hood treated by a conservative approach. Eur J Radiol 2015; 84 (02) 278-283
- 50 Lee SA, Kim BH, Kim SJ, Kim JN, Park SY, Choi K. Current status of ultrasonography of the finger. Ultrasonography 2016; 35 (02) 110-123
- 51 James N, Farrell N, Mauck B, Calandruccio J. Sagittal band injury and extensor tendon realignment. Orthop Clin North Am 2022; 53 (03) 319-325
- 52 Westerheide E, Failla JM, van Holsbeeck M, Ceulemans R. Ultrasound visualization of central slip injuries of the finger extensor mechanism. J Hand Surg Am 2003; 28 (06) 1009-1013
- 53 To P, Watson JT. Boutonniere deformity. J Hand Surg Am 2011; 36 (01) 139-142
- 54 Rothwell AG. The pseudo-boutonniere deformity. N Z Med J 1979; 89 (628) 51-54
- 55 Wang T, Qi H, Teng J, Wang Z, Zhao B. The role of high frequency ultrasonography in diagnosis of acute closed mallet finger injury. Sci Rep 2017; 7 (01) 11049
- 56 Rubin G, Ammuri A, Mano UD. et al. Outcome differences between conservatively treated acute bony and tendinous mallet fingers. J Clin Med 2023; 12 (20) 12
- 57 Sever C, Kilinc BE, Sen AE, Varol A, Oc Y. The application of tenodermodesis in the treatment of chronic mallet finger in young basketball players. Langenbecks Arch Surg 2025; 410 (01) 232
