The complex etiology of chronic wrist pain is inherently related to the anatomic structures that comprise the wrist as well as the biomechanical forces that may contribute to developing chronic pain. Though not as widely used as physical exam testing, current literature suggests that ultrasound of the wrist compartments can be useful in diagnosing wrist pain etiologies. Assessment of patient history alongside visualization of anatomy should be crucial in the assessment of chronic wrist pain as it is efficient and objective. A 25-year-old right-handed female presented with chronic right radial wrist pain for one year with insidious onset. The pain presented in sporadic episodes with occasional "catching" symptoms after certain movements. Ultrasound imaging of the first compartment illustrated notable fluid collection with septal inflammation surrounding the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. Both physical exam testing and ultrasound imaging proffered a diagnosis of severe DeQuervain’s tenosynovitis (DQT). After four months of conservative management, her symptoms have almost completely resolved and repeat ultrasound was recommended. In addition to ultrasound utilization in diagnostics, it can also be used to differentiate anatomic variation prior to invasive surgical treatments, leading to an overall decrease in post-operative complications. This is particularly important for our patient, as existing literature notes a septum between the APL and EPB is only present in about 10% of the population. Should our patient have required surgical release of the tendon sheath, this anatomic variation would have been missed if not for the diagnostic utility of ultrasound. This case report illustrates the importance of ultrasound imaging to diagnose complex musculoskeletal complaints and suggests the bypass of uncomfortable and subjective physical exam testing.
