Anatomy, Variants, and Multimodality Imaging of Flexor Carpi Radialis Tendon Pathology and Post-Therapeutic Evaluation

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INTRODUCTION: The flexor carpi radialis tendon (FCR tendon) is an important anatomical structure of the wrist, frequently implicated in radial-sided pain. FCR tendon disorders include tenosynovitis, tendinopathy, partial or complete tears, and compressive syndromes such as trapezial tunnel syndrome. Knowledge of anatomical variants, pathophysiology, and imaging techniques is essential for accurate diagnosis and management. METHODOLOGY: This educational narrative review is based on a structured, non-systematic review of the literature, supplemented by representative imaging findings from clinical practice. It focuses on the anatomy, variants, pathology, multimodality imaging findings, and post-therapeutic evaluation of the flexor carpi radialis tendon. RESULTS: The FCR tendon exhibits notable anatomical complexity, including variants that may influence clinical presentation and surgical planning. Multimodality imaging has been used to characterize tendinopathy, tenosynovitis, partial or complete tears, synovial sheath cysts, calcifications, and associated scaphotrapeziotrapezoid joint abnormalities. Surgical procedures involving the FCR tendon-including trapezial tunnel decompression, tenodesis, tendon transfers, and ligament reconstruction-require imaging follow-up to assess tendon integrity, postoperative changes, and potential complications. Dynamic ultrasound and MRI are particularly useful in routine clinical practice for evaluating these conditions. CONCLUSION: This educational narrative review highlights practical imaging insights derived from the literature and illustrated by representative clinical cases. Multimodality imaging plays an important role in the diagnosis and post-therapeutic evaluation of FCR tendon disorders and contributes to patient management in routine clinical practice.

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