Case Challenge

Hand & Wrist

Stephen J Pomeranz

Gain confidence interpreting Wrist MRI Cases with MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME!

Case Review

Musculoskeletal (MSK)

Case 1 - 35-year-old female presents with pain shooting to right fingers

Case 2 - 15-year-old female gymnast presents with pain of right wrist

Case 3 - 26-year-old female presents with right wrist pain

Case 4 - 14-year-old female presents with ulnar-sided left wrist pain for three weeks

Case 5 - 36-year-old female presents with right wrist pain

Case 6 - 19-year-old male presents with pain mid dorsal right wrist

Case 7 - 58-year-old female presents with mild pain in right wrist

Case 8 - 68-year-old male presents with ulnar-sided left wrist pain

Case 9 - 13-year-old male presents with moderate right wrist pain

Case 10 - 36-year-old female patient was boxing, and hit her partner's elbow

Case 11 - 18-year-old male presents with pain and weakness in left wrist for two weeks

Case 12 - 53-year-old male presents with moderate to severe, sharp and dull, right wrist pain

Case 13 - 59-year-old female presents with severe pain and swelling in right wrist

Case 14 - 67-year-old female presents with rheumatoid arthritis

Case 15 - 60-year-old female presents with ulnar-sided pain in right wrist

Case 16 - 43-year-old male presents with right wrist pain, and right thumb numbness

Case 17 - 62-year-old male presents with possible scapholunate injury

Case 18 - 46-year-old male presents with left wrist pain, swelling, and stiffness

Case 19 - 32-year-old male presents with volar right wrist swelling

Case 20 - 50-year-old female presents with left wrist pain since feeling a pop

Case 21 - 45-year-old female presents with laceration in right wrist

Case 22 - 49-year-old female presents with injury of the left wrist

Case 23 - 57-year-old male presents with right wrist pain

Case 24 - 59-year-old male presents with mild dull pain when pushing on right wrist

Case 25 - 19-year-old female presents with history of ganglion cyst

Case 26 - 53-year-old female presents with radial pain in the left wrist

Case 27 - 17-year-old male presents with pain in left wrist since fall

Case 28 - 55-year-old female presents with right ulnar region mass

Case 29 - 68-year-old female presents with pain in right wrist

Case 30 - 43-year-old female tripped 10 days ago, and landed on her left wrist

Case 31 - 36-year-old male presents with pain in ulnar aspect of right wrist

Case 32 - 50-year-old male presents with radial-sided right wrist pain since work-related falling injury

Case 33 - 64-year-old female presents with left wrist pain for one month

Case 34 - 67-year-old female presents with moderate pain and lump on right wrist

Case 35 - 51-year-old female presents with a left wrist pain

Case 36 - 14-year-old female presents with mild to moderate, constant dull pain in right wrist

Case 37 - 16-year-old male presents with mild to moderate pain and swelling in right wrist for five months

Case 38 - 16-year-old female presents with worsening left wrist pain, and swelling

Case 39 - 20-year-old male presents with pain with flexion and extension

Case 40 - 55-year-old female presents with right wrist pain and swelling

Case 41 - 31-year-old male presents with pain around the scaphoid region of the left wrist

Case 42 - 11-year-old female presents with chronic left wrist pain

Case 43 - 50-year-old female presents with mass in right wrist

Case 44 - 43-year-old female presents with pain in right wrist

Case 45 - 36-year-old female presents with right wrist pain for several years

Case 46 - 35-year-old female presents with right wrist triangular fibrocartilage complex (TFCC) pain

Case 47 - 55-year-old male presents with a one year history of episodic left wrist pain

Case 48 - 57-year-old male presents with right wrist freezing and locking up

Case 49 - 21-year-old female presents with palmar right wrist pain over the carpal tunnel region

Case 50 - 39-year-old male presents with left wrist pain since injury seven months prior

Course Evaluation

Post-Course Activities

This Power Pack is comprised of 50 unique Wrist MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Wrist MRI Cases

<div>HISTORY:&#160;This 68-year-old female presents with pain in right wrist. Patient's pain has been worsening over the last six months with decreased mobility and decreased strength.(QUIZ ANSWER) PRIMARY FINDING:&#160;Flexor carpi radialis tear.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Ulnar styloid intact. Subchondral pseudocyst formation in a pattern of ulnolunate abutment demonstrated. Perforation of the radial third of the triangular fibrocartilage disc demonstrated. Ulnomeniscal homologue, extensor carpi ulnaris intact. Thin distal radioulnar joint fusion. Dorsal and volar ligaments of the distal radioulnar joint intact.&#160;Severe scaphotrapezoid chondromalacia with subchondral pseudocyst formation and extensive edema throughout the distal pole of the scaphoid. Malalignment of the carpal rows likely from microinstability. Chronic tear through the dorsal scapholunate ligament, with degeneration of the remaining segment and associated mild scapholunate gapping. Associated dorsal intercalated segmental instability posture (DISI).&#160;Extensive osteophytic spurs project volar from the scaphotrapezoid articulation likely abutting the adjacent flexor carpi radialis which demonstrates an adjacent approximately 2cm split tear and hypertrophic tendinopathy. The remaining flexor and extensor tendons of the wrist intact. Secondary swelling from flexor carpi radialis and peritendinitis abut the carpal tunnel. No fat seen within the carpal tunnel which demonstrates bowstringing. Suggestion of enlargement of the median nerve as it exits the carpal tunnel. No evidence of ulnar entrapment neuropathy. Moderate thenar fatty atrophy noted. Hypothenar musculature intact.&#160;Moderate 1st carpometacarpal arthropathy. No macrofracture.&#160;CONCLUSION:&#160;1. 2cm split tear involving the swollen, severely tendinopathic flexor carpi radialis at the level of the scaphotrapezoid articulation which demonstrates advanced arthropathy and volar osteophytes that likely contribute to friction-related degeneration of the adjacent flexor carpi radialis. Associated flexor carpi radialis peritendinitis without complete tear or retraction.&#160;2. Swelling from the previously mentioned FCR tendon tear and peritendinitis contribute to stenosis of the carpal tunnel without visualized internal fat and demonstration of bowstringing of the superficial retinaculum. Swelling of the post carpal tunnel median nerve along with moderate fatty atrophy of the thenar musculature raise concern for a subacute carpal tunnel syndrome which should be correlated for sensation disturbance involving the 2nd and 3rd digits.&#160;3. Ulnolunate abutment chondromalacic changes with perforation of the radial third of the triangular fibrocartilaginous disc. Constellation of findings compatible with a palmar class 2C lesion.&#160;4. Degenerative tears of the scapholunate ligament with mild scapholunate disassociation contribute to DISI posture (dorsal intercalated segmental instability). No evidence of frank scapholunate advanced collapse (SLAC) wrist at this time.&#160;</div>

Case

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