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38b - Answer: 16-year-old female presents with worsening left wrist pain, and swelling

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

HISTORY: 

This 16-year-old female presents with worsening left wrist pain, and swelling. Patient participates in competitive gymnastics.

(QUIZ ANSWER) PRIMARY FINDING: 

Overuse Syndrome.

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

FINDINGS:

Growth plates are opened. No paraphyseal widening of the distal radius. Rather, stippled edema within the epiphysis of the radius, ulna, proximal carpal row, and base of the capitate and proximal hamate. Subchondral microtrabecular pseudocysts are seen within the volar lunate. 

Scapholunate, LT ligaments are intact. TFCC is intact with normal albeit swollen ECU subsheath, foveal, and styloid attachments. 

In the dorsum of the wrist at the site of pain distal to Lister's tubercle, swelling is identified between the 3rd and 4th extensor compartments; mild extensor tendinosis identified. Curvilinear intraarticular fluid signal dorsal to the proximal carpal row is shown deep to these ligaments without discrete ganglion.

Swelling at base of radioscaphocapitate ligament. 

Extrinsic radioscaphocapitate and long radiolunate ligament structures in the volar wrist intact. 

CONCLUSION:

Dorsal capsular swelling without interruption of intercarpal ligaments. Suspect chronic dorsal capsular injury.

1. Diffuse synovial swelling with multifocal regions of subchondral osseous edema, greatest in the lunate. Favor overuse injury without macrofracture, JIA unlikely.

2. Mild reactive tendinosis of the extensor digitorum group of the dorsal wrist. No micro or macrofracture. 

3. Swelling at base of radioscaphocapitate ligament.

LESSON 3, TOPIC 39

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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