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44b - Answer: 43-year-old female presents with pain in right wrist

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

HISTORY: 

This 43-year-old female presents with pain in right wrist going to first two fingers, getting worse. Felt a pop followed by severe pain. Thumb surgery seven months prior.

(QUIZ ANSWER) PRIMARY FINDING: 

Rupture of the flexor carpi radialis tendon.

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

FINDINGS: 

Rupture of the flexor carpi radialis tendon close to its insertion, the proximal end of the retracted tendon located over the palmar aspect of the distal radial metaphysis. Total length of defect measures 4 cm. The visualized retracted tendon is edematous and frayed with extensive surrounding soft tissue swelling for another 1.5 cm.

Trapezium resection arthroplasty noted. Mild bony irregularity and spurring base of the 1st metacarpal.

The remainder of the flexor tendons and extensor tendons are normal. Carpal tunnel and Guyon's canal normal. Thenar and hypothenar muscle volume and signal normal.

Chronic degeneration and fraying of the scapholunate ligament with mild scapholunate interval widening (Geissler 1-2). Scaphoid intact. Lunate morphology and position normal. Synovitis within the triangular fibrocartilage complex. Articular disc swollen but intact. Minimal intercarpal arthrosis.

CONCLUSION:

1. Rupture of the flexor carpi radialis tendon near its insertion, proximal end of the retracted tendon located at the level of the distal radial metaphysis (4 cm gap with further 1.5 cm of proximal frayed tendon). Status post trapezium resection arthroplasty.

2. Subtle intermediate signal of the median nerve within the carpal tunnel incidentally noted.

LESSON 3, TOPIC 57

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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