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30b - Answer: 43-year-old female tripped 10 days ago, and landed on her left wrist

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

HISTORY: 

This 43-year-old female tripped 10 days ago, and landed on her left wrist. There was a pop and now swelling. Decreased strength. History of carpal tunnel surgery four years prior.

(QUIZ ANSWER) PRIMARY FINDING: 

Prominent thinning of inner third of triangular fibrocartilage.

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

FINDINGS:

Flexor and extensor tendons are intact. Ill-defined signal along the flexor retinaculum consistent with prior release. No tenosynovitis at the level of the carpal tunnel. No ulnar bursitis is demonstrated. 

Triangular fibrocartilage demonstrates prominent thinning of its inner third. No discrete tear is demonstrated. Scapholunate ligament and lunotriquetral ligament are intact. No osseous fracture, AVN, or mass is demonstrated. 

Dorsal inflammation for which capsulitis or capsulosynovitis is favored. A slit-like dorsal ganglion cyst is favored over region of dorsal capsular prolapse measuring approximately 4 x 5 x 4.5mm in size. 

CONCLUSION: 

1. Prominent degenerative thinning of the inner third of the TFC without discrete or well-defined tear. Small effusion within the distal radioulnar joint and radiocarpal joint and minimal chondral thinning or chondral fraying of the proximal lunate cartilage. 

2. No osseous fracture, AVN, or mass. 

3. No scapholunate ligament or lunotriquetral ligament tear is demonstrated. 

4. Dorsal inflammation for which a combination of capsulitis and capsular sprain is favored. Slit-like dorsal ganglion cyst measuring 4 x 5 x 4.5mm is contributory.

LESSON 3, TOPIC 15

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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