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

Abstract

Background The tendons of the hand run in close proximity to each other and within retinacular tunnels adjacent to articular joints, while forming intersections in characteristic locations. The enclosing tendon sheaths are often sites of systemic or infectious inflammation.

Method This review article outlines the different entities of tendon and tendon sheath pathology and their manifestation in the hands. Diagnostic findings in tendon and tendon sheath disorders are illustrated using MRI imaging and discussed in context with the current literature.

Results and Conclusion Overuse may cause stenosis in the fibrous outer layer of the retinacula and the A1 annular ligaments as well as tendinosis. In contrast, proliferative tenosynovitis is a disease of the synovial inner layer of the tendon sheath with tendon infiltration and tendinitis. Pyogenic tenosynovitis favors the flexor compartments. Because of the narrow spaces in the hand, a high-resolution MRI technique must be used.

Key Points: 

• Diseases of the tendons and tendon sheaths may have a mechanical, degenerative, metabolic, systemic inflammatory, or infectious etiology.

• Fibrous tunnels and bony prominences in close proximity to crossing tendons predispose to mechanical tendon irritation at typical sites of the hand.

• Stenosing tenovaginitis occurs in the fibrous layer of the extensor retinaculum or the A1 annular pulleys. The most frequent manifestations are the “trigger finger” and de Quervain disease.

• Proliferative tenosynovitis affects the synovial layer of the tendon sheaths before infiltrating the tendons. The classic representative is rheumatoid arthritis.

Citation Format

• Schmitt R, Hesse N, Grunz JP. Tendons and Tendon Sheaths of the Hand – An Update on MRI. Fortschr Röntgenstr 2022; 194: 1307 – 1321

Zusammenfassung

Hintergrund Die Sehnen der Hand verlaufen eng benachbart, teils überkreuzend und an artikulären Umlenkorten innerhalb von retinakulären Tunnelsystemen. Die umhüllenden Sehnenscheiden sind häufig Manifestationsorte systemischer oder infektiöser Entzündungen.

Methode In der Übersichtsarbeit werden die Krankheitsentitäten der Sehnen- und Sehnenscheiden mit der Pathophysiologie und den klinischen Erscheinungsbildern beschrieben. Die Diagnostik der Sehnenerkrankungen wird anhand der MRT-Bildgebung erläutert und mit der aktuellen Literatur diskutiert.

Ergebnisse und Schlussfolgerung Überlastungen können zu Stenosen in den fibrösen Außenschichten der Retinakula und der A1-Ringbänder sowie zu Tendinosen führen. Dagegen ist die proliferative Tenosynovialitis eine Erkrankung der synovialen Innenschicht der Sehnenscheide mit Sehneninfiltration und Tendinitis. Die purulente Tenosynovialitis bevorzugt die Flexorenkompartimente. Wegen der engen Raumverhältnisse an der Hand müssen hochaufgelöste MRT-Techniken verwendet werden.

Kernaussagen: 

• Erkrankungen der Sehnen und Sehnenscheiden können mechanische, degenerative, metabolische, systemische, entzündliche oder infektiöse Ursachen haben.

• An der Hand prädisponieren Tunnelengen, Knochenvorsprünge sowie eng benachbarte und kreuzende Sehnen zur mechanischen und topografischen Sehnenirritation.

• Stenosierende Tendovaginosen spielen sich im Stratum fibrosum des Retinaculum extensorum oder der A1-Ringbänder ab. Häufigste Vertreter sind der „Trigger-Finger“ und die Tenovaginosis de Quervain.

• Proliferative Tenosynovialitiden betreffen das Stratum synoviale, bevor sie im Sinne einer sekundären Tendinitis in die Sehnen infiltrieren. Klassischer Vertreter ist die rheumatoide Arthritis.

Key words

tendons - hand - fingers and toes - anatomy - inflammation - MR imaging

Publication History

Received: 11 January 2022

Accepted: 16 March 2022

Article published online:
15 June 2022

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