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37b - Answer: 16-year-old male presents with mild to moderate pain and swelling in right wrist for five months

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

HISTORY: 

This 16-year-old male presents with mild to moderate pain and swelling in right wrist for five months.

(QUIZ ANSWER) PRIMARY FINDING: 

Palmer 1 A abnormality.

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

FINDINGS:

Perforated inner third TFC. Suspect central third rupture Palmer 1A. Peripheral attachment synovitis. 

Fracture through the base of the ulnar styloid. Osteoedema and swelling. No transcortication or union demonstrated. 

Intact intrinsic ligaments. 

Microfracturing within the capitate proximally and less so trapezoid and uncinate process of the hamate. No displaced macrofracture or fragment. 

Flexor and extensor tendon complexes are intact. 

Dissecting ganglion cyst dorsal to the capitolunate articulation and scaphoid approximately 1.2 x 0.9 x 0.5cm. Flat 9mm ganglion ventral to the radial styloid. 

IMPRESSION:

Right Wrist: Transverse fracture through the base of the ulnar styloid. Osteoedema and swelling. No complete transcortication or union demonstrated. 

Microfracturing with portions of the capitate, trapezoid and uncinate process of the hamate without carpal macrofracture. 

Dorsal capsulitis and / or capsular sprain. Small septated dorsal capsular ganglion. 

Flat ganglion cyst ventral to the distal radius.  

Perforated inner third TFC. Suspect central third rupture Palmer 1A. Peripheral attachment synovitis.

LESSON 3, TOPIC 36

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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