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 59-year-old female presents with severe pain and swelling in right wrist. Injured while cutting wood nine months prior. Limited range of motion.(QUIZ ANSWER) FAVORED DIAGNOSIS:&#160;Rheumatoid arthritis.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: History of bridging from triscaphe fusion involving scaphoid, capitate, greater and lesser multangular, but sparing the CMC.&#160;A pattern of massive intra-articular swelling throughout the distal and proximal carpal row with reactive edema and erosions throughout the carpus is more compatible with a primary inflammatory arthropathy than diffuse septic arthropathy involving multiple compartments and spaces.&#160;Possible considerations include rheumatoid arthritis, seronegative spondyloarthropathies, but crystalline-induced arthropathies are less likely.&#160;The process is too diffuse for Lyme disease.&#160;A mechanical etiology is implausible due to the diffuseness of the process even though a small perforation or fenestration exists in the TFC. Virtually every portion of the joint is involved including the DRUJ.&#160;A dissecting capsulosynovial cyst may be an amenable source for joint aspiration and synovial analysis using the MRI as a guide and ultrasound of the hand to direct needle placement, as such collection resides around the flexor tendons three and four primarily. Rheumatologic workup should also carefully be entertained.&#160;CONCLUSION:&#160;Trauma history may be a "red herring" in this patient who has had prior surgical fusion and now presents with innumerable foci of osteoedema, erosive change, and capsulosynovial inflammation and thickening for which an inflammatory non-infectious etiology is favored over septic arthritis and other etiologies. Recommendations and detail are given in the body of the report. The favored diagnosis is RA or rheumatoid arthritis.</div>

Case

Which of the following is the MOST LIKELY favored diagnosis?