52-year-old male with medial wrist pain and burning sensation while shoveling

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52-year-old male complaining of medial pain since feeling a burning sensation while shoveling and doing yard work 1 month ago. Assess for triangular fibrocartilage tear. 

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

  • The bones are in anatomic alignment. Abnormal multidirectional linear low T1 bone marrow signal is identified within the lunate associated with osteoedema consistent with comminuted complicating infractions. Moderate surrounding capsular swelling inflammation and early collapse secondary to Kienbock’s disease.
  • Moderate edema and swelling of the dorsal intercarpal ligament noted consistent with intermediate-grade sprain. Small radioulnar joint effusion noted. 
  • Complex central third TFC tear with lunato-chondromalacia most likely exacerbated by Kienbock’s disease. Peripheral ulnar capsule synovitis. Early degeneration of the scapholunate ligament without ulnar translocation of the lunate.  The lunatotriquetral ligament is intact.
  • Focal ECU tendinosis and tenosynovitis noted. The remaining extensor tendons are intact. The flexor tendons are without abnormality. 
  • The carpal tunnel is preserved. No evidence of bulging. The median nerve is normal in caliber and signal intensity. No evidence of entrapment. 
  • The muscles about the wrist are intact without evidence of hemorrhage tear or strain. 
  • No soft tissue mass.

KIENBOCK’S DISEASE

  • Comminuted complicating infractions of the lunate with moderate surrounding soft tissue swelling and early collapse secondary to Kienbock’s disease. 
  • Dorsal intercarpal ligament sprain and generalized capsulitis. Small dorsal common ganglion.
  • Complex central third TFC tear with lunato-chondromalacia most likely exacerbated by Kienbock’s disease. Peripheral ulnar capsule synovitis.
  • Focal ECU tendinosis. 
  • Early degeneration of the scapholunate ligament without ulnar translocation of the lunate.

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