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Wk 10, Case 1, Hand/Wrist MR - Review

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Report

Patient History

68M c/o pain over hamate hook and Guyon's canal. Left hand ulnar neuropathy. Query mass or vascular lesion compressing ulnar nerve.

Findings

ALIGNMENT:

Ulnar Variance: Neutral.

Carpal Instability: Suspected due to the presence of chondromalacia mostly at the scaphotrapeziotrapezoidal and capitate.

ARTICULATIONS:

Thumb Carpometacarpal Joint: Moderate osteoarthrosis with radial subluxation of the metacarpal base. Chronic tearing and delamination of the anterior oblique ligament at the ulnar side, dorsal radial, dorsal central and posterior oblique ligaments at the radial side.

Scaphotrapeziotrapezoidal Joint: Moderate osteoarthrosis and chondromalacia.

Pisiform-Triquetral Joint: Mild osteoarthrosis with associated bursitis and synovitis.

Radiocarpal Joint: Normal.

Distal Radioulnar Joint: Penetrating chondromalacia and subchondral arthropathic cysts at the medial aspect of the radius and triquetrum.

Carpal Effusion: Small effusion with capsular synovitis.

Distal Radioulnar Joint Effusion: Minimal.

INTRINSIC LIGAMENTS:

Scapholunate Ligament: Intact.

Lunotriquetral Ligament: Intact.

Triangular Fibrocartilage: Degenerative central pinhole tear at the disc proper. The foveal and styloid attachments and the meniscus homologous are intact. Associated with radius and triquetral chondromalacia, these findings are in keeping with Palmer class 2C injury.

Lunate Facet: Normal.

Hamate-Lunate Facet: Normal.

Extensor Compartment:

I: The abductor pollicis longus and extensor pollicis brevis are intact.

II: The extensor carpi radialis longus and brevis are intact.

III: The extensor pollicis longus is intact.

IV: The extensor digitorum communis is intact.

V: The extensor digiti minimi is intact.

VI: A 3.5 cm longitudinal superficial delamination of the distal extensor carpi ulnaris. Associated mild tenosynovitis.

Flexor Compartment: The flexor digitorum superficialis, profundus and flexor pollicis longus appear intact.

Carpal Tunnel: No space-occupying lesions.

Median Nerve: Normal.

Flexor Retinaculum: Not thickened.

Guyon's Canal: Partially thrombosed, ectatic aneurysmal dilation of the ulnar artery 1 cm distal to the Guyon's canal measuring 6 mm x 5 mm x 7 mm (AP, transverse and CC). No additional space-occupying lesions.

OTHER FINDINGS:

Skeleton: No acute fracture or dislocations.

Soft Tissues: Mild periarticular soft tissue swelling.

Vessels: As described.

Impressions

1. Partially thrombosed, ectatic aneurysmal dilation of the ulnar artery 1 cm distal to the Guyon's canal measuring 6 mm x 5 mm x 7 mm (AP, transverse and CC).

2. Palmer class 2C injury with central pinhole tear at the disc proper, lunate and radius chondromalacia.

3. A 3.5 cm longitudinal superficial delamination of the distal extensor carpi ulnaris with associated mild tenosynovitis.

4. Moderate degenerative changes of the 1st CMC joint.

5. Thenar eminence interstitial muscular lipoma just over 1cm in length and deep to the abductor pollicis muscle.

Case Discussion

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Gitanjali Bajaj, MD

Assistant Professor

University of Arkansas for Medical Sciences

Edward Smitaman, MD

Clinical Associate Professor

University of California San Diego

Brian Y. Chan, MD

Assistant Professor of Musculoskeletal Radiology

University of Utah

Tags

Musculoskeletal (MSK)

MRI

Hand & Wrist

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