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35b - Answer: 51-year-old female presents with a left wrist pain

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

HISTORY: 

This 51-year-old female presents with a left wrist pain since motor vehicle crash two weeks prior.

(QUIZ ANSWER) PRIMARY FINDING: 

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 bones are in anatomic alignment. Linear low T1 signal is identified within the waist of the scaphoid associated with extensive osteoedema and surrounding effusion consistent with a fracture. A small cortical defect is seen within the dorsal aspect of the lunate associated with osteoedema concerning for an additional fracture.

Mild 1st metacarpophalangeal joint arthrosis and capsulitis noted.

The scapholunate and lunatotriquetral ligaments are intact. The triangular fibrocartilage is intact. No TFC tear.

The extensor and flexor tendons are intact. No tendinopathy or tear.

The carpal tunnel is preserved. No bowing of the retinaculum seen.

The median nerve is normal caliber and signal intensity. No evidence of entrapment.

The visualized muscles are intact. No hemorrhage tear or strain.

No soft tissue mass.

Dorsal capsular swelling and edema seen.

CONCLUSION:

1. Scaphoid waist fracture associated with small surrounding effusion and moderate dorsal capsular swelling.

2. Tiny cortical defect / fracture of the dorsal lunate, suspected.

3. No TFC tear.

LESSON 3, TOPIC 30

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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