Wk 5, Case 3 - Review

Patient History
62-year-old female with increased density and stippling of the lunate. Mass on right posterior wrist causing pain.

Findings

ALIGNMENT:

Ulnar Variance: Neutral.

Distal Radioulnar Joint: Normal.

Carpal Instability: No dorsal or volar intercarpal segmental instability. No scapholunate advanced collapse.

ARTICULATIONS:

Thumb Carpometacarpal Joint: Thickening of the anterior oblique ligament with mild malalignment, marginal osteophytes and subcortical intraosseous cysts in the ulnar aspect of the 1st metacarpal base.

Scaphotrapeziotrapezoidal Joint: Normal.

Pisiform-Triquetral Joint: Normal.

Radiocarpal Joint: Normal.

Distal Radioulnar Joint: Normal.

Fluid: As described above.

Carpal Effusion: None.

Distal Radioulnar Joint Effusion: Mild.

INTRINSIC LIGAMENTS:

Scapholunate Ligament: Derangement and insufficiency of the dorsal band of the scapholunate ligament with 4 mm diastasis of the corresponding joint.

Lunotriquetral Ligament: Intact.

Triangular Fibrocartilage: Chronic autodigestion or large perforation of the triangular fibrocartilage complex disc proper.

Lunate Facet: Chondromalacia of the lunate and triquetrum.

Hamate-Lunate Facet: Normal.

Extensor Compartment: No tendinosis, tenosynovitis or tears.

Flexor Compartment: No tendinosis, tenosynovitis or tears.

Carpal Tunnel: No space-occupying lesions in the carpal tunnel.

Median Nerve: Normal.

Flexor Retinaculum:

Flexor Tendons: No tendinosis, tenosynovitis or tears.

Guyon's Canal: No space-occupying lesions.

OTHER FINDINGS:

Skeleton: Confluent sclerosis and mild osteoedema involving the entire lunate. Early depression of the proximal cortical surface of the lunate without pronounced or overt collapse.

Soft Tissues: A 0.3 cm x 1.1 cm (AP x transverse) lobulated cystic structure in the dorsal aspect of the wrist overlying the Lister tubercle in keeping with a ganglion pseudocyst.

Vessels: Unremarkable.

Impressions
1.Chronic Kienbock disease without fragmentation or collapse.
2.Chronic wearing or perforation of the TFCC disc proper with mild fluid distension of the distal radioulnar joint and associated with lunate chondromalacia (Palmer class 2C).
3.A 0.3 x 1.1 cm ganglion pseudocyst in the dorsal aspect of the wrist overlying the Lister tubercle.