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1b - Answer: 54-year-old male presents with severe pain in left hand and thumb

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

HISTORY: 

This 54-year-old male presents with severe pain in left hand and thumb for 15 years. History of work injury 15 years prior, with hyperextended thumb. History of physical therapy and pain medication. 

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

Chronically thickened or markedly hypertrophic fibrotic ulnar collateral ligament of first metacarpophalangeal joint.

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

FINDINGS:

No acute bony macrofracture or contusion. Small areas of osteochondral erosion at dorsal base of first proximal phalanx and juxtaposing head of the metacarpal. The ulnar collateral ligament is thickened, likely due to previous sprain. No acute sprain. The radial collateral ligament intact. Flexor and extensor tendons intact. 

No acute muscle strain. 

IMPRESSION:

Left Hand: Chronically thickened or markedly hypertrophic fibrotic ulnar collateral ligament of first metacarpophalangeal joint, likely due to old sprain. No acute sprain. 

Small foci of osteochondral erosion in the base of first proximal phalanx and juxtaposing first metacarpal head, osteoarthritic in origin.

LESSON 2, TOPIC 3

Case Challenge: Thumb & Finger MRI Cases

Case Challenge

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Content reviewed: October 27, 2021

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