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31b - Answer: 36-year-old male presents with pain in ulnar aspect of right wrist

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

HISTORY: 

This 36-year-old male presents with pain in ulnar aspect of right wrist, getting worse. Injury at work three months prior pulling himself up out of a seven foot hole.

(QUIZ ANSWER) PRIMARY FINDING: 

Scapholunate ligament tear.

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

FINDINGS: 

Bone island is noted within the scaphoid. Widening of the scapholunate interval is present. Scapholunate ligament is torn. TFCC and lunotriquetral ligament are intact.

Moderate effusion within the radiocarpal joint and midcarpal joint. This prolapses dorsally. Reactive synovial hypertrophy or synovial thickening is contributory.

Dorsal tilt of the lunate relates to dorsal intercalated segmental instability.

Low-grade marrow edema within the carpals and minimally the distal radius relates to stress change or contusion.

Median and ulnar nerves are unremarkable.

CONCLUSION:

1. Complete tear with irregular margins involves the scapholunate ligament. Scapholunate interval is widened measuring up to 8 mm transversely. Diffuse capsulitis and capsulosynovitis involve the radiocarpal joint and midcarpal joint.

2. Dorsal intercalated segmental instability.

3. Stress change or contusion throughout the carpals and less so distal radius, ulna and minimally the proximal metacarpals.

LESSON 3, TOPIC 18

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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