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41b - Answer: 31-year-old male presents with pain around the scaphoid region of the left wrist

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

HISTORY: 

This 31-year-old male presents with pain around the scaphoid region of the left wrist from jammed wrist two months prior.

(QUIZ ANSWER) PRIMARY FINDING: 

Comminuted fracture of the triquetrum.

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

FINDINGS:

The osseous structures demonstrate a remote chronic comminuted fracture of the triquetrum. Multiple bodies, some of which are sclerotic, are also seen adjacent to the triquetrum and dorsum of the wrist just dorsal and superficial to the capitate. Advanced carpal arthrosis with multiple erosions likely the sequelae of previous trauma. 

Chronic scapholunate ligament tear with an approximately 7mm gap between the scaphoid and the lunate. No scaphoid rotation or migration. Developing early SLAC wrist and hypertrophy of the radial styloid process. Sagittal images also demonstrate a DISI posture. Lunotriquetral ligament is intact. TFCC is intact. 

Distal radioulnar joint articulation is normal. 

Carpal tunnel and median nerve are within normal limits. The flexor tendons and extensor tendons are normal. 

A small ganglion measuring 0.5cm is seen in the dorsum of the wrist just deep to the 4th extensor compartment at the level of the distal radius. 

Thumb musculature is preserved. 

CONCLUSION: 

1. Remote trauma to the wrist with a comminuted fracture of the triquetrum, scapholunate ligament tear with widening of the scapholunate interval without scaphoid rotation. 

2. Early SLAC wrist. 

3. DISI posture.

LESSON 3, TOPIC 48

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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