Case Challenge

Hand & Wrist

Stephen J Pomeranz

Gain confidence interpreting Wrist MRI Cases with MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME!

Case Review

Musculoskeletal (MSK)

Case 1 - 35-year-old female presents with pain shooting to right fingers

Case 2 - 15-year-old female gymnast presents with pain of right wrist

Case 3 - 26-year-old female presents with right wrist pain

Case 4 - 14-year-old female presents with ulnar-sided left wrist pain for three weeks

Case 5 - 36-year-old female presents with right wrist pain

Case 6 - 19-year-old male presents with pain mid dorsal right wrist

Case 7 - 58-year-old female presents with mild pain in right wrist

Case 8 - 68-year-old male presents with ulnar-sided left wrist pain

Case 9 - 13-year-old male presents with moderate right wrist pain

Case 10 - 36-year-old female patient was boxing, and hit her partner's elbow

Case 11 - 18-year-old male presents with pain and weakness in left wrist for two weeks

Case 12 - 53-year-old male presents with moderate to severe, sharp and dull, right wrist pain

Case 13 - 59-year-old female presents with severe pain and swelling in right wrist

Case 14 - 67-year-old female presents with rheumatoid arthritis

Case 15 - 60-year-old female presents with ulnar-sided pain in right wrist

Case 16 - 43-year-old male presents with right wrist pain, and right thumb numbness

Case 17 - 62-year-old male presents with possible scapholunate injury

Case 18 - 46-year-old male presents with left wrist pain, swelling, and stiffness

Case 19 - 32-year-old male presents with volar right wrist swelling

Case 20 - 50-year-old female presents with left wrist pain since feeling a pop

Case 21 - 45-year-old female presents with laceration in right wrist

Case 22 - 49-year-old female presents with injury of the left wrist

Case 23 - 57-year-old male presents with right wrist pain

Case 24 - 59-year-old male presents with mild dull pain when pushing on right wrist

Case 25 - 19-year-old female presents with history of ganglion cyst

Case 26 - 53-year-old female presents with radial pain in the left wrist

Case 27 - 17-year-old male presents with pain in left wrist since fall

Case 28 - 55-year-old female presents with right ulnar region mass

Case 29 - 68-year-old female presents with pain in right wrist

Case 30 - 43-year-old female tripped 10 days ago, and landed on her left wrist

Case 31 - 36-year-old male presents with pain in ulnar aspect of right wrist

Case 32 - 50-year-old male presents with radial-sided right wrist pain since work-related falling injury

Case 33 - 64-year-old female presents with left wrist pain for one month

Case 34 - 67-year-old female presents with moderate pain and lump on right wrist

Case 35 - 51-year-old female presents with a left wrist pain

Case 36 - 14-year-old female presents with mild to moderate, constant dull pain in right wrist

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

Case 38 - 16-year-old female presents with worsening left wrist pain, and swelling

Case 39 - 20-year-old male presents with pain with flexion and extension

Case 40 - 55-year-old female presents with right wrist pain and swelling

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

Case 42 - 11-year-old female presents with chronic left wrist pain

Case 43 - 50-year-old female presents with mass in right wrist

Case 44 - 43-year-old female presents with pain in right wrist

Case 45 - 36-year-old female presents with right wrist pain for several years

Case 46 - 35-year-old female presents with right wrist triangular fibrocartilage complex (TFCC) pain

Case 47 - 55-year-old male presents with a one year history of episodic left wrist pain

Case 48 - 57-year-old male presents with right wrist freezing and locking up

Case 49 - 21-year-old female presents with palmar right wrist pain over the carpal tunnel region

Case 50 - 39-year-old male presents with left wrist pain since injury seven months prior

Course Evaluation

Post-Course Activities

This Power Pack is comprised of 50 unique Wrist MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Wrist MRI Cases

<div>HISTORY:&#160;This 50-year-old female presents with mass in right wrist that started on right distal forearm two years prior. Very painful. Also, has many small bumps on right wrist. Has shooting pain in right hand and arm. Right forearm / wrist mass, mass 5cm proximal wrist crease. No known injury, cancer, or wrist surgery.(QUIZ ANSWER) PRIMARY FINDING:&#160;Neurilemmoma.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: A 1.9cm length mass approximately 1.6cm in diameter, is present along the radial aspect of the wrist, centered 5.2cm from the radiostyloid. A small vessel or nerve branch extends directly to the mass and then from the mass. It is likely the source. Differential includes a neoplasm such as a neural cell origin tumor (neurilemmoma favored over neurofibroma given the well-marginated character and speckled appearance). Less likely a myxoid neoplasm. Even less likely a vascular lesion given the lack of pulsation, although a sealed pseudoaneurysm (calcified with a lamellated margin on MRI) may be considered. Unlikely a true aneurysm. A dynamic contrast-enhanced study will be of value prior to surgery.Moderate arthropathy of the wrist with capsulitis.&#160;Scapholunate ligament is intact. Lunotriquetral ligament is not well demonstrated. TFC shows chronic degeneration and thinning in particular involving the junction of the inner one-third with the middle one-third. Peripheral TFC is intact.&#160;Extensor carpi ulnaris shows moderate tendinopathy and subtle chronic interstitial tear within the tendon. The tear is centered at the level of the ulnar styloid.&#160;The remaining extensor and flexor tendons are intact.&#160;Neurovascular bundles are unremarkable.&#160;No AVN, OCD or fracture. No malalignment at this time.&#160;No additional masses.&#160;Furthermore, contrast enhanced study may be of value in fully evaluating the small bumps on the wrist described in the history but not seen as discrete masses on today's study.&#160;CONCLUSION:&#160;1. A 1.9cm length mass approximately 1.6cm in diameter, is present along the radial aspect of the wrist, centered 5.2cm from the radiostyloid. A small vessel or nerve branch extends directly to the mass and then from the mass. It is likely the source. Differential includes a neoplasm such as a neural cell origin tumor (neurilemmoma favored over neurofibroma given the well-marginated character and speckled appearance). Less likely a myxoid neoplasm. Even less likely a vascular lesion given the lack of pulsation, although a sealed pseudoaneurysm (calcified with a lamellated margin on MRI) may be considered. Unlikely a true aneurysm. A dynamic contrast-enhanced study will be of value prior surgery.&#160;2. Moderate arthropathy of the wrist with capsulitis.&#160;3. Extensor carpi ulnaris shows moderate tendinopathy and subtle chronic interstitial tear within the tendon.&#160;4. Furthermore, contrast enhanced study may be of value in fully evaluating the small bumps on the wrist described in the history but not seen as discrete masses on today's study.&#160;ADDENDUM:&#160;These results were confirmed by direct visualization at surgery to arise from the radial nerve and favored to represent a neurilemmoma by the surgeon.&#160;</div>

Case

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