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12b - Answer: 55-year-old female presents with pinching pain in left hand

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 55-year-old female presents with severe, constant dull, pinching pain in left hand and wrist for one month. History of plates, screws in both wrists, broke. History of surgery and meds. Difficulty using hand. Weakness in fingers. Swelling and discoloration of hand.

DISORDER UNDER WHICH THIS CASE WOULD MOST LIKELY FALL: 

Complex regional pain syndrome, type 1 (previously known as RSD).

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS

Extensive soft tissue swelling throughout the hand.     

Only a scant amount of swelling is centered about the tendons.

Scattered areas of marginal marrow edema.

Although there is arthritis at the scaphomultangular and first CMC along with swelling of the carpometacarpal junctions throughout, such would not explain the diffuse nature of the process.

Therefore, the differential diagnosis lies between cellulitis and the favored diagnosis of reflex sympathetic dystrophy now known as primary regional pain syndrome or complex regional pain syndrome type 1.

No bone destruction identified.   

IMPRESSION:

Left Hand: Myriad findings which together favor a complex regional pain syndrome type 1, previously known as RSD over diffuse cellulitis.

LESSON 2, TOPIC 36

Case Challenge: Hand MRI Cases

Case Challenge

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Content reviewed: July 19, 2021

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