39b - Answer: 20-year-old male presents with pain with flexion and extension
HISTORY:
This 20-year-old male presents with pain with flexion and extension, and when using hand to push off to stand up since wrist injury one month prior.
(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:
The bones are in anatomic alignment. Bone marrow signal is normal without evidence of occult fracture, stress fracture or bone contusion. Arthropathic changes are identified within the triquetrum and lunate. Moderate joint effusion noted.
The scapholunate and lunatotriquetral ligaments are intact. A tiny central perforation of the triangular fibrocartilage is suggested consistent with a Palmer class 1A tear. Swelling and inflammation of the meniscal homologue noted consistent with contusion.
The extensor tendons are without abnormality. The flexor tendons are intact.
The carpal tunnel is preserved. No evidence of bulging. The median nerve is normal in caliber and signal intensity. No evidence of entrapment.
The visualized muscles are intact without evidence of hemorrhage, tear or strain.
No soft tissue mass.
No subcutaneous edema or swelling.
CONCLUSION:
1. Palmer class 1A lesion of the triangular fibrocartilage associated with meniscal homologue contusion.
2. Moderate joint effusion.
3. Arthrosis of the lunate and triquetrum. Given this fact and the attritional appearance of the LT ligament, this may be the exceptional case where MR arthrography elucidates the presence of intrinsic ligamentous injury or rupture. If arthrography is not preferred, the patient can be brought back for steep radial and ulnar deviation coronal views to look for LT instability.
Case Challenge: Wrist MRI Cases
Case Challenge
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Content reviewed: September 28, 2021