Wk 5, Case 4 - Review

Patient History
61-year-old female with left wrist pain and swelling.

Findings

ALIGNMENT:

Ulnar Variance: Neutral.

Distal Radioulnar Joint: Dorsal subluxation of the distal ulna.

Carpal Instability: Multifocal intraosseous synovial pits or “ganglions” in keeping with biomechanical friction sequelae.

ARTICULATIONS:

Severe arthrosis of the wrist articular surfaces with diffuse penetrating erosions, reactive osteoedema of the carpal bones and the proximal 3rd and 4th metacarpal bases with widening of the distal radioulnar joint. Dorsal subluxation of the distal ulna. Radial subluxation of the 1st metacarpal base at the 1st carpometacarpal joint.

Carpal Effusion: Diffuse fluid distension and reactive synovitis throughout the radiocarpal and intercarpal joints associated with capsular laxity, capsulosynovitis and pannus formation, which is more conspicuous in the dorsal wrist.

Distal Radioulnar Joint Effusion: Fluid distension of the distal radioulnar joint.

INTRINSIC LIGAMENTS:

Scapholunate Ligament: Diffuse swelling and laxity of the scapholunate ligament without complete rupture.

Lunotriquetral Ligament: Intact.

Triangular Fibrocartilage: Chronic maceration of the triangular fibrocartilage complex (TFCC) disc proper and its attachments.

Extensor Compartment: Tenosynovitis of the extensor compartment tendons sparing the 1st extensor compartment (abductor pollicis longus and extensor pollicis brevis). Hypertrophic delamination with split tear of the extensor carpi ulnaris measuring about 5-6 cm.

Flexor Compartment: Intact.

Carpal Tunnel: Normal.

Median Nerve: Normal.

Flexor Retinaculum: No thickening or palmar bowing.

Flexor Tendons: No tendinosis, tenosynovitis or tendon rupture.

Guyon's Canal: Normal.

Impressions
1.Severe left wrist osteoarthrosis associated with diffuse joint effusion and extensive capsulosynovitis, synovial hypertrophy and pannus formation, constellation of findings highly suspicious for a systemic inflammatory condition, favoring rheumatoid arthritis.
2.Dorsal subluxation of the distal ulna at the radioulnar joint with widening of the radioulnar joint space secondary to radioulnar ligament and capsular laxity.
3.Diffuse extensor compartment tenosynovitis sparing the 1st extensor compartment and 5-6 cm hypertrophic delamination of the extensor carpi ulnaris tendon.
4.Chronic maceration of the TFCC disc proper and its attachments.