34-year-old male with pain wrapping around the wrist

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Wrist sprain pain wrapping around the wrist that worsens with activity.

Long- and short-axis fat- and water-weighted images were obtained before and after contrast administration. Contrast Type: Dotarem 0.5mmol/ml 10mL prefilled NDC 67684-2000-5 Contrast Amt: 10. 1.5T High Field Oval.

  • Mild widening of the SL interval without ligamentous disruption. However the dorsal portion of the scapholunate ligament is swollen. In addition at the membranous portion of the scapholunate ligament is a round smooth sclerotic-rimmed soft tissue mass most compatible with an interosseous ganglion pseudocyst. A focal capsular cyst is less likely as there is a paucity of capsular fluid. Size 4.3mm. And intraosseous ganglion is also identified at the scaphoid tubercle.
  • A dorsal common ganglion is seen just distal to the dorsal scapholunate ligament at the usual locus. Its overall size estimated at 7mm.
  • Given the wrapping nature of the patient’s pain consider steep dorsal and radial deviation to look for dynamic instability of the SL interval. However given the paucity of reactive arthritis in the scaphoid and lunate suspect stability on performance of such.
  • Triangular fibrocartilage normal.

Three ganglia or ganglion pseudocysts: Interosseous; intraosseous; and dorsal common ganglion at the distal SL ligament and capsule. Mildly swollen dorsal limb of the SL ligament. In the proper setting and if the clinical syndrome warrants consider steep radial and ulnar deviation views to search for dynamic instability.

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