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 67-year-old female presents with rheumatoid arthritis, and prior surgery for tendon repair in right wrist.(QUIZ ANSWER) PRIMARY FINDING IN THIS CASE:&#160;Late-stage chronic distal radioulnar joint (DRUJ) 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: There is late-stage course of the rheumatoid arthritis demonstrated in the radioulnar joint. The hallmark of rheumatoid arthritis is demonstrated in the radial DRUJ. The DRUJ demonstrates extensive synovitis and erosions and deformity in the ulnar styloid process as well as radial end. There are also fibrocystic changes seen in the distal ulna. Radial carpal joint also demonstrated. Advanced arthropathy, more likely represent arthritis rather than rheumatoid arthritis.&#160;There is fraying out of the TFCC demonstrated. The scapholunate ligament is also frayed and mild diastasis is also demonstrated in the scapholunate joint. Lunotriquetral joint is not widened. No marginal erosions or subarticular stress-induced change is demonstrated in the scapholunate and lunotriquetral joint. No development of intercarpal arthritis is demonstrated.&#160;The first carpometacarpal joint also demonstrates mild deformity and ligamentous laxity without arthropathy. The first metacarpophalangeal joint demonstrates altered joint conformity, mild stress-induced osteoedema, mild subluxation and ligamentous laxity, consistent with moderate osteoarthrosis. In fact, a bony segmentation is appreciated or developing in the radial end, just superior to the scapholunate joint space measuring approximately 5mm.&#160;The carpal tunnel is intact without tendinosis or tenosynovitis. The extensor tendons are unremarkable. No myoedema or muscle atrophy is demonstrated. The thenar and hypothenar muscles are intact.&#160;CONCLUSION:&#160;1. Late-stage chronic DRUJ rheumatoid arthritis with severe synovitis, severe bony deformity and erosions, fibrocystic change, and concomitant severe attritional change of the TFCC. No tenosynovitis.&#160;2. Advanced radiocarpal osteoarthritis with altered marginal deformity and a developing 5 mm bony fragment, chondral erosions, stress-induced osteoedema, and scapholunate ligamentous insufficiency is favored over rheumatoid arthritis.&#160;3. Mild-to-moderate first metacarpophalangeal osteoarthrosis.</div>

Case

Abductor pollicis and flexor pollicis brevis tears

Subarticular stress-induced change in scapholunate and lunotriquetral joints

Late-stage chronic distal radioulnar joint (DRUJ) rheumatoid arthritis

What is the primary finding in this case?