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 22 - 50-year-old male cannot bend left hand ring finger fully

<div>HISTORY:&#160;This 50-year-old male cannot bend left hand ring finger fully for eight weeks. Numbness at the tip of the finger, and dull pain.PULLEY TEAR AND DISRUPTION OF WHICH DIGIT:&#160;4th.&#160;Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: There is dysfunction of the A2 pulley with retraction of torn fibers between the tendon and proximal phalanx and discontinuity of the fibers. There is tissue swelling and edema between the volarly displaced flexor tendon and the proximal phalanx. Disruption of the C1 (cruciate) pulley noted as well.&#160;The more distal flexor tendon at the level of the mid and distal phalanx of the 4th digit is unremarkable.&#160;The visualized portions of the 2nd, 3rd, and 5th digits are unremarkable as well. Soft tissues intact.&#160;No evidence of soft tissue or bony contusion. No erosive changes evident. No evidence of high-grade arthropathy.&#160;Musculature about the hypothenar and thenar eminence unremarkable as well.&#160;There is no evidence of macrotear of the flexor tendon; however, peritendinitis noted as well at the more proximal aspect.&#160;IMPRESSION: Tear of the annular pulley (A2 pulley) of the 4th digit with volar displacement of the flexor tendon.&#160;Disruption of the cruciate pulley (C1) of the 4th digit as well.&#160;No evidence of flexor injury; however, associated 4th digit flexor tendinitis evident.</div>

Case

There is a tear of the annular pulley (A2 pulley), and disruption of the cruciate pulley (C1), of which digit?