Case Challenge

Hand & Wrist

Stephen J Pomeranz

Gain confidence interpreting Hand MRI with practice cases from MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME. Try it free!

Case Review

Musculoskeletal (MSK)

Post-Course Activities

This Power Pack is comprised of 25 unique Hand MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Hand MRI Cases

Case 18 - 41-year-old male presents with right hand pain

<div>HISTORY:&#160;This 41-year-old male presents with right hand pain. No known injury. History of inflammatory arthritis, per patient.THERE IS NO EVIDENCE OF COLLATERAL LIGAMENT TEAR AT 2nd METACARPOPHALANGEAL JOINT:True.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: The intrinsic musculature of the hand appears robust and the adductor pollicis, is more prominent than typically encountered, related to hypertrophy of the transverse head.The flexor digitorum superficialis tendon associated with the index finger is not visualized, within the hand at the level of the 2nd metacarpal. In that expected anatomic location, a muscle belly. The muscle belly is visualized from the level of the proximal portion second metacarpal to the level of the second metacarpophalangeal joint. More distally, a tendon is evident in the expected distribution of the flexor digitorum superficialis.&#160;When reviewing the carpal tunnel contents, no identifiable flexor digitorum superficialis tendon.&#160;The muscle origin is difficult to confirm but appears to originate from the flexor digitorum superficialis of the middle finger and possibly the flexor digitorum profundus of the index finger.&#160;When reviewing the sagittal data set, the first metacarpal has a curved appearance, with the apex of the curve directed dorsally. Furthermore, the morphology results in a palmarly directed articular surface of the second metacarpal. In neutral hand position, the proximal phalanx is somewhat dorsally positioned relative to the second metacarpal head.No evidence for an abnormality of the extensor tendons associated with the index finger. No abnormality of the flexor digitorum profundus associated with the index finger.&#160;Degenerative arthrosis of the first MCP joint. Articular remodeling with osteophytosis and narrowed joint space. Palmar subluxation of the proximal phalanx relative to the first metacarpal. This may reflect the consequence of increased tensile forces from the hypertrophied transverse head of the adductor pollicis.&#160;No evidence for a collateral ligament tear associated with the second metacarpophalangeal joint.&#160;Interosseous ganglion radial aspect third metacarpal head.&#160;CONCLUSION:&#160;1. Anatomic anomaly of absence of the flexor digitorum superficialis tendon of the index finger from the level of the carpal tunnel to the level of the second metacarpophalangeal joint. In the expected distribution of that tendon, a muscle belly arises distal to the carpal tunnel and gives rise to the flexor digitorum superficialis tendon at the level of the 2nd MCP.&#160;2. Curved appearance of the second metacarpal may reflect the consequence of the anatomic anomaly described in Conclusion #1 and reflect chronic osseous remodeling due to altered tensile forces.&#160;3. Hypertrophic appearance of the transverse head adductor pollicis with degenerative arthrosis first metacarpophalangeal joint and subluxation of the proximal phalanx.4.&#160;No collateral ligament tear at the 2nd MCP joint or extensor mechanism abnormality of the index finger.</div>

Case

There is no evidence of collateral ligament tear at the 2nd metacarpophalangeal joint.