Wk 1, Case 1 - Review

Patient History
49-year-old male with right wrist pain in the scapholunate area, off and on after a fall 2 years ago and getting worse

Findings

ALIGNMENT:
Ulnar Variance: Normal.

Distal Radioulnar Joint: Mildly displaced, oblique intraarticular fracture at the dorsal aspect of the distal radial epiphysis without evidence of osseous bridging and instability suggested by the presence of subcortical cysts at the fragment margins and mild osteoedema. The Lister tubercle is involved.

Carpal Instability: None.

ARTICULATIONS:
Thumb Carpometacarpal Joint: Normal.

Scaphotrapeziotrapezoidal Joint: Normal.

Pisiform-Triquetral Joint: Normal.

Radiocarpal Joint: Moderate sprain of the dorsal intercarpal ligament.

Distal Radioulnar Joint: Normal.

Fluid: None.

Carpal Effusion: None.

Distal Radioulnar Joint Effusion: None.

INTRINSIC LIGAMENTS:
Scapholunate Ligament: Intact.

Lunotriquetral Ligament: Intact.

Triangular Fibrocartilage: Disc proper, proximal and distal bands of the triangular ligament in their foveal and styloid attachments as well as the meniscus homologous are intact.

Lunate Facet: Normal.

Hamate-Lunate Facet: Normal.

Extensor Compartment:
I: Normal.

II: Normal.

II: Approximately 3cm long split tear of the extensor pollicis longus as it courses over the Lister's tubercle associated with diffuse increased intrasubstance signal intensity and fibrotic changes with fluid distention along the course of its tendon sheath.

IV: Diffuse increased intrasubstance signal intensity and fibrotic changes with fluid distention along the course of the tendon sheath of the extensor digitorum and extensor indicis.

V: Normal.

VI: Tendinopathy with increased intrasubstance signal intensity of the extensor carpi ulnaris as it courses over the ulnar styloid with an intact extensor retinaculum.

Flexor Compartment: Normal.

Carpal Tunnel: No space-occupying lesions in the flexor compartment.

Median Nerve: Normal.

Flexor Retinaculum:

Flexor Tendons: Normal.

Guyon's Canal: Normal.

OTHER FINDINGS:
Skeleton: As described above.
Soft Tissues: As described above.
Vessels: Normal neurovascular bundles.

Impressions
1. Mildly displaced, nonunited intraarticular dorsal Barton fracture with suggestion of instability by the presence of subcortical cysts at the fracture margins. Mild osteoedema. The fracture involves the Lister's tubercle.
2. Long segment split tear of approximately 3cm long involving the extensor pollicis longus as it courses over the Lister's tubercle associated with tenosynovitis, tendinosis and fibrotic changes along its tendon sheath. Suspect a component of crossover syndrome secondary to Lister’s tubercle deformity and a cicatrized extensor retinaculum.
3. Tendinosis and tenosynovitis with fibrotic changes involving the extensor digitorum and extensor indicis.
4. Short-segment split tear and tendinosis of the extensor carpi ulnaris as it courses over the ulnar styloid. Intact extensor retinaculum.