51-year-old female - Hand was jerked by a dog on a leash

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Case History

51-year-old female complaining of pain since a dog leash jerked her thumb backwards.

Technical Factors

Long- and short-axis fat- and water-weighted images were performed on 1.5T High Field Oval.

Case Findings

The bones are in anatomic alignment. The bone marrow signal is normal without evidence of occult fracture stress fracture or bone contusion. An arthropathic pseudocyst is identified within the lunate. First carpometacarpal arthrosis noted with marginal spurring and moderate capsuloligamentous inflammation. No substantive joint effusion.
Degeneration of the superficial and deep anterior oblique collateral ligaments medially so called beak ligament complex.
Edema and stretching of the scapholunate ligament noted concerning for low- to intermediate-grade sprain. 3mm of diastasis. Early arthrosis. Suspect membranous deficiency. The lunatotriquetral ligament is intact. The triangular fibrocartilage is intact. No TFC tear.
Marked thickening and edema of the 1st extensor group tendons noted with a striated appearance and moderate surrounding fluid and thickening of the tendon sheath consistent with de Quervain tenosynovitis. An associated split tear but not transection of the abductor pollicis longus tendon noted. The remaining extensor tendons are without abnormality. The flexor tendons are intact. No tendinopathy or tear.
Negative ulnar variance posture.
The carpal tunnel is preserved. No bowing of the retinaculum seen.
The median nerve is normal in caliber and signal intensity. No evidence of entrapment.
The visualized muscles are intact without evidence of hemorrhage tear or strain.
No soft tissue mass.

Case Conclusion

Moderately severe de Quervain’s tenosynovitis with a split tear but not transection of the abductor pollicis longus tendon.
Moderate 1st carpometacarpal arthrosis and capsuloligamentous inflammation. Degeneration of the superficial and deep anterior oblique collateral ligaments medially so called beak ligament complex.
Low- to intermediate-grade sprain of the scapholunate ligament. 3mm of diastasis. Early arthrosis. Suspect membranous deficiency.
Negative ulnar variance posture.
Arthropathic pseudocystic change of the lunate.

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