Sonopath Forum

suspect flexor carpi lunaris tendonopathy, rule out neoplasia

7 year old FS Sharpei mix w/ 1 month hx of swelling just proximal to accessory carpal bone, seems to be getting worse. Looks like recently getting more swollen. Some mild discomfort on ROM. Grade II/V lameness at walk to trot. Feels to be associated w/ muscle into tendon more proximally. rDVM did a FNA and was concerned about cells w/ large nucleus and scant cytoplasm – did not send slide in to clin path. I am planning to re-aspirate and send in. On ultrasound, I can talk myself in to the swelling being associated w/ the flexor carpi ulnaris, but would love your input based on images provided. There is a hypoechoic core that makes me a bit nervous for neoplasia. Also wondering on the still that I placed arrows if you can confirm the tendons I’m seeing – superficial digital flexor at surface, flexor carpi ulnaris in middle and not sure about deep to those two – ulnaris lateralis?

Comments

N_ondreka

September 10, 2016 at 9:47 am -

On the long axis video the

On the long axis video the focal swelling seems to be distal to the accessory bone??

Everything looks like a chronic partial rupture with ongoing biomechanical failure to me – mostly with degeneration/chronic repetitive microtrauma in the beckground. However, I cannot really see the transition to the tendon on these loops so I lack a bit confidence here based on the limited info I have.

FCU tendinopathy is commonly bilateral. Did you scan the other limb for comparison?

Would repeat the FNA

kromero

September 10, 2016 at 3:03 pm -

Hi – thank you for the

Hi – thank you for the reply. I’ve had to decrease the videos to 3 seconds in order to upload to Sonopath, so I appologize that you may not have long enough clips. The transverse view seemed to be the best for being able to visualize some more distinct tendon fibers dorsal to the lesion. I am awaiting FNA. I did scan the other limb and there is not evidence of tendiopathy on ultrasound or palpation.

N_ondreka

September 10, 2016 at 3:42 pm -

Absolutely no worries. Im

Absolutely no worries. Im placing my bets on FCU tendinopathy until proven oherwise 😉

kromero

September 13, 2016 at 5:02 pm -

I received the cytology

I received the cytology results = mesenchymal cells w/ no evidence of neoplastic cells. Interpretation = probably reactive fibroplasia. Other comments – the mesenchymal cells could also be consistent with reactive fibroblasts.

I’ve trying to attach two more images that look like they did not upload originally. The still has arrows. My interpretation was the superficial digital flexor is most ventral, flexor carpi ulnaris in the center and likely deep digital flexor deepest as was more towards midline. I have another video I’m trying to attach, but don’t see a way to do it from here. I will try to send it to Kelly. It is a longitudinal video that may show the transition from tendon to disease area better.

I’m inclined to proceed w/ rehabilitation at this point. Our rehab crew usually offers injections of triamcinolone or PRP w/ laser and therapeutic ultrasound in the first month, then progressing to strengthening in the second and third months. Thinking we should avoid laser (and stem cells). Any additional thoughts?

September 14, 2016 at 3:40 am -

Sorry kromero this is turning

Sorry kromero this is turning into a telemedicine consultation which would best be served by submitting through “upload telemed” icon on the home page as you are getting into treatment recommendations and so forth… that runs into a grey area and best served as a telemed consult and beyond the forum concept.

I can suggest also the orthopedic US seminar taught by Dr Ondreka and colleagues in Hohokus NJ (20 min north from ewr) in November. Everything ortho with the probe will be covered as well as small parts and “anything goes” lab time to clean up any US issues you wish.

http://sonopath.com/events/past-events/presentations-2016