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32b - Answer: 50-year-old male presents with radial-sided right wrist pain since work-related falling injury

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

HISTORY: 

This 50-year-old male presents with radial-sided right wrist pain since work-related falling injury. There is limited range of motion in the thumb, exacerbated when moving the thumb.

(QUIZ ANSWER) PRIMARY FINDING: 

Active de Quervain's disease.

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

FINDINGS:

Osseous structures appear grossly intact and exhibit normal marrow signal. Small pseudocysts or interosseous ganglia are noted in the distribution of the capitate, hamate, scaphoid, lunate, and triquetrum. The intercarpal articulations appear preserved. There is no evidence of scapholunate or lunatotriquetral ligamentous disruption. The TFC complex appears intact. 

Flexor and extensor tendons appear grossly intact. Diffuse fluid signal is identified surrounding the extensor pollicis brevis and abductor pollicis longus tendons. Short-segment slit-like concealed small interstitial tear is identified in the distribution of the extensor pollicis brevis and abductor pollicis longus tendons. No macrotear. Active de Quervain's disease.

CONCLUSION:  

1. Active de Quervain's disease.

2. Tenosynovitis involving the extensor pollicis brevis and abductor pollicis longus tendons, accompanied by short-segment slit-like concealed small interstitial tear involving the extensor pollicis brevis and swelling of the slips abductor pollicis longus tendons. This finding provides a mechanism for the radial-sided wrist pain. No macrotear.

3. No evidence of recent fracture or traumatic scapholunate dissociation.

LESSON 3, TOPIC 21

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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