The FCR tendon passes through a narrow fibro-osseous tunnel within the groove of the trapezium bone before inserting on the second (and occasionally third) metacarpal base. This tunnel is distinct from the carpal tunnel and can independently compress the FCR tendon. FCR tendinopathy within the trapezial tunnel is a cause of radial-sided wrist pain that is distinct from de Quervain's and scaphoid pathology.
Wrist flexion and radial deviation force transmission through the trapezial canal
FCR tunnel syndrome produces radial wrist pain reproduced by direct pressure over the trapezium and resisted wrist flexion with radial deviation. It is distinguished from de Quervain's by its more palmar location and from scaphoid pathology by its absence from the anatomical snuffbox. Ultrasound or MRI confirms tendon signal change and sheath distension within the trapezial canal.
FCR tendon compression in the trapezial canal producing radial wrist pain managed with injection or surgical tunnel release.
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