Wrist – Negative variance

CASE HISTORY

Pain joint hand.

TECHNICAL FACTORS

Multiplanar imaging was performed prior to and following intraarticular (or intravenous) injection of gadolinium solution.

KEY IMAGES

This case has no key images.

CASE FINDINGS

• Generalized capsulosynovitis but most notable along the ulnocarpal articulation. Arthrogram injected into the proximal carpal row and at the ulnocarpal articulation showing pooling of contrast at both locations. No communicating tear to the distal carpal row. 
• Ulnar minus variation with a prominent and synovitic TFC. Interdigitating synovitis particularly along the palmar aspect of the ulnocarpal articulation. Degenerative changes but no well-defined TFC tear. 
• Scapholunate ligament shows interstitial swelling and mild widening of the interval without a communicating tear. The lunate concavity is rotated slightly dorsally but not an overt dorsal intercalated segmental instability at this time. Early scapholunate ligament deficiency. 
• Lunotriquetral ligament is intact. 
• No fracture or AVN. 
• Extensor and flexor tendons are intact with the extensor carpi ulnaris perched medially. No subsheath extension of contrast. No ECU tendon tear. The remaining flexor and extensor tendons are intact. Neurovascular bundles are unremarkable. 
• Minimal DRUJ synovitis. 

CASE CONCLUSION

• Generalized capsulosynovitis but most notable along the ulnocarpal articulation. Arthrogram injected into the proximal carpal row and at the ulnocarpal articulation showing pooling of contrast at both locations. No communicating tear to the distal carpal row. 
• Ulnar minus variation with a prominent and synovitic TFC. Interdigitating synovitis particularly along the palmar aspect of the ulnocarpal articulation. Degenerative changes but no well-defined TFC tear. 
• Scapholunate ligament shows interstitial swelling and mild widening of the interval without a communicating tear. The lunate concavity is rotated slightly dorsally but not an overt dorsal intercalated segmental instability at this time. Early scapholunate ligament deficiency. 
• ECU intact.
• Negative variance likely contributes to ulnar styloidal/prestyloidal recess bursitis and perhaps incidental pisotriquetral bursitis.