MRI of the Wrist

Marcos Loreto Sampaio, MD; Nicholas M. Kolanko, MD


Appl Radiol. 2014;43(10) 

In This Article


The flexor and extensor tendons present typical low signal intensity and constant diameter on all sequences. Tendinopathy presents as signal and thickness changes on MRI, and may progress to partial- or full-thickness tears, with or without associated fluid and synovitis of the sheath(tenosynovitis, Figure 11). Note that the magic angle effect may artifactually increase the signal of normal tendons oriented approximately 54° in relation to the main magnetic field on sequences with a short time of echo, such as T1- and PD-weighted sequences. This not infrequently affects the extensor pollicis longus tendon (third extensor compartment).

Figure 11.

Axial PD-weighted image with fat suppression. (A) DeQuervain's tenosynovitis. Intrinsic signal changes and fluid in the sheath of the first extensor compartment tendons (arrow). (B) Patient with inflammatory arthropathy and tenosynovitis. There is increased fluid in the sheaths of multiple extensor compartments and flexor tendons (arrows).

While most cases of tenosynovitis are due to overuse/degenerative changes, other etiologies such as gout, rheumatoid arthritis, amyloidosis, septic and mycobacterial tenosynovitis and sarcoidosis remain in the differential diagnosis. In addition to tenosynovitis, gout is especially known to cause dramatic alterations in tendon signal and caliber (Figure 12).

Figure 12.

Gout. (A) Axial T1-weighted image reveals intermediate signal intensity infiltration of the flexor tendons and tenosynovitis (arrow). (B) Coronal T2-weighted image with fat suppression reveals expansion of the synovial sheath and infiltration of the flexor tendons (arrows).

An intersection syndrome refers to pain and swelling at areas of intersection between the tendon compartments. A proximal intersection syndrome refers to the crossing between the first and second extensor compartments at the distal dorsal radial aspect of the forearm, whereas a distal intersection syndrome refers to the crossing between the third and second compartments at the level of the tubercle of Lister. Findings include focal peritendinous edema, tendon thickening and tenosynovitis.[23,24]

In cases of trauma with tendon retraction, the tendinous stumps should be identified and the protocol tailored to the clinical question, for example, by enlarging the field of view, substituting the coil, or complementation with forearm MRI.