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26b - Answer: 53-year-old female presents with radial pain in the left wrist

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

HISTORY: 

This 53-year-old female presents with radial pain in the left wrist. Patient injured wrist while skiing. Patient has a history of rheumatoid arthritis.

(QUIZ ANSWER) PRIMARY FINDING: 

Comminuted scaphoid fracture.

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

FINDINGS:

The scapholunate ligament is intact. 

Slight stretching of the scapholunate ligament is noted. 

The lunatotriquetral ligament is normal. 

Slight swelling of the ulnar capsule with the TFC and TFCC intact. Suspect sprain of the distal attachments. 

Dominant finding is a comminuted fracture that involves the waist and proximal pole with an oblique orientation and then extends in a vertical-oblique orientation towards the distal scaphoid tubercle. 

At this juncture, no evidence of avascular necrosis is noted. 

The epicenter of the fracture is in the waist. 

No scaphoid rotation or evidence of lunate displacement is noted. 

No disruption of the radioulnar articulation.

Small osteochondral erosion of the radius. 

Flexor and extensor tendons are intact. 

CONCLUSION: 

1. Findings consistent with comminuted relatively nondisplaced scaphoid fracture predominantly centered in the waist but with extension distally and no evidence of avascular necrosis. 

2. Stretching injury without disruption of the scapholunate ligament.

LESSON 3, TOPIC 3

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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