Musculoskeletal Ultrasound of Psoriatic Dactylitis Revealing Flexor Tenosynovitis

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A 37-year-old Caucasian male with psoriatic arthritis (PsA) presented with a left hand fourth digit stiffness and decreased range of motion. On examination, the digit was diffusely swollen consistent with dactylitis. Musculoskeletal ultrasound* revealed a normal proximal interphalangeal joint with remarkable flexor tenosynovitis (Fig. A).
Ultrasound imaging of dactylitis can identify different patterns of soft tissue involvement generated by variable combinations of flexor tenosynovitis, surrounding edema, and synovitis of the interphalangeal and metacarpophalangeal joints.1 In tenosynovitis, distension of the tendon sheath with fluid or synovial thickening may be identified on ultrasound.2 Our patient responded well to a flexor tenosynovium injection with triamcinolone acetonide (Fig. B).

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