Rodrigo O. Carvalho de Aguiar MD, Presenter: Nothing to Disclose

Rodrigo Yacubian Fernandes MD, Abstract Co-Author: Nothing to Disclose

Debbie Trudell, Abstract Co-Author: Nothing to Disclose

Donald L. Resnick MD, Abstract Co-Author: Nothing to Disclose

To demonstrate the macroscopic anatomy with MR imaging, US, and pathologic correlation of the radial and ulnar bursae of the wrist and their relationship to the flexor tendons in the palmocarpal region.

MR tenography of the flexor pollicis longus (FPL) and flexor digiti minimi (FDM) tendons sheaths of 10 fresh human cadaveric hands was performed using a mixture of gadolinium, iodine, and colored gelatin. US and MR appearance of the bursae and their communications with the flexor tendon sheaths of the fingers was analyzed and compared with those seen on anatomic section. In two cadaveric hands, histology was obtained at the level of the carpal tunnel.

In all specimens, the tendon sheath of the FPL communicated with the radial bursa and in 80 percent of specimens, the tendon sheath of the FDM communicated with the ulnar bursa. At the level of the carpal tunnel, and just proximal and distal to it, communication between these two bursae was evident in all cases. In two specimens an intermediate bursa communicated with the ulnar and radial bursae. In coronal and sagital images, the ulnar and radial bursae had a “figure of eight”, or “hourglass”, shape with the constricted part located at the level of the carpal tunnel. The deep fold of the ulnar bursa arose more proximally and the intermediate and superficial layers, at a more distal level. Histologically, the orientation of the synovial membrane of the ulnar bursa at the carpal level was in a dorsopalmar direction instead of the radio-ulnar configuration that is depicted in most references.

The ulnar and radial bursae of the wrist often communicate, forming a common bursa that extends distally to the flexor tendons. The radial bursa communicates with the FPL tendon sheath and the ulnar bursa may communicate with the FDM tendon sheath, explaining some patterns of spread of inflammatory and infectious diseases of the hand. Bursitis, rather than tenosynovitis, is the proper term to describe inflammatory changes of synovial tissue within the carpal tunnel.

Aguiar, R, Fernandes, R, Trudell, D, Resnick, D, Radial and Ulnar Bursae of the Wrist: Cadaveric Investigation of Regional Anatomy Using MR Imaging and Ultrasonography.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4410241.html