Flexor Carpi Radialis (FCR) Tenderness

Exams and Signs

Historical Overview

The most recent influential work on flexor carpi radialis (FCR) tendinitis was published by Bishop and colleagues in 1994.¹

Description

Patients experience FCR tenderness on the FCR tendon, radial to the palmaris longus (PL) on the volar-radial aspect of the wrist.² The FCR tendon is found within a few millimeters of the distal aspect of the radius, the scaphoid tubercle, the scaphotrapezio-trapezoidal (STT) joint, and the carpometacarpal (CMC) joint of the thumb.³
Patients with FCR tenderness may be involved in farming, industrial work or electronics.⁴ They may also play racquet sports, golf or baseball.²

Pathophysiology

FCR tenderness and pain can be caused by FCR tendinitis or scaphoid fracture.¹
If the FCR tendon is tender proximal to the volar wrist crease and the volar wrist tenderness is recreated with resisted wrist flexion, this may indicate stenosing tenosynovitis.⁵
Another cause of FCR tenderness and swelling is STT arthritis. Radial ulnar deviation of the wrist frequently causes pain because the STT joint experiences increased motion during this activity.²

Instructions

Record the patient’s history, including any sports-related injuries. Ask the patient to rate how much pain s/he usually experiences in the affected wrist on a scale from 1 to 10.
Palpate the FCR tendon with resisted wrist flexion and radial deviation.²
Check for tenderness, swelling and/or pain over the FCR tendon.
Examine the contralateral wrist for comparison.

Variations

Patients with diabetes mellitus may be susceptible to stenosing tenosynovitis.¹ In tenosynovitis, there may be median nerve involvement.⁴

Related Signs and Tests

Diagnostic Performance Characteristics

With radiographic evidence, corticosteroid injections into the tendon sheath and joint may help to establish the diagnosis and the appropriate course of treatment.¹
Do not use other patients’ reactions as a comparison, because other patients may have different perceptions of similar tenderness and/or pain.

Presentation Photos and Related Diagrams

Identifying FCR Tenderness

Palpating for FCR tenderness. Remember the scaphoid tuberosity is immediately under the distal FCR tendon.

Definition of Positive Result

A positive result occurs when there is increased tenderness at the FCR tendon with pressure.

Definition of Negative Result

A negative result occurs when pressure does not cause increased tenderness at the FCR tendon.

Comments and Pearls

For FCR tendinopathy, non-operative treatments such as corticosteroid injections are often helpful.¹Immobilization with brace or cast is also helpful.
If conservative treatments do not provide relief, operative approaches may include decompression of the tendon sheath and the distal aspect of the fibro-osseous tunnel.²

Diagnoses Associated with Exams and Signs

Videos

Palpating for FCR tenderness

References

McAuliffe JA. Tendon Disorders of the Hand and Wrist. J Hand Surg Am 2010;35A:846-53. PMID: 20438999
Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
Bishop AT, Gabel G, Carmichael SW. Flexor carpi radialis tendinitis. Part I: Operative anatomy. J Bone Joint Surg Am 1994;76(7):1009-14. PMID: 8027107
Armstrong TJ, Fine LJ, Goldstein SA et al. Ergonomics considerations in hand and wrist tendinitis. J Hand Surg Am 1987;12A:830-7. PMID: 3655257
Rayan G, Akelman E. The Hand: Anatomy, Examination, and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012