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45b - Answer: 36-year-old female presents with right wrist pain for several years

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

HISTORY: 

This 36-year-old female presents with right wrist pain for several years with tenderness on the ulnar side.

(QUIZ ANSWER) PRIMARY FINDING: 

Extensor carpi ulnaris tendinosis.

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. The bone marrow signal is normal without evidence of occult fracture, stress fracture or bone contusion. Arthropathic changes noted within the distal capitate. No joint effusion. 

The scapholunate and lunatotriquetral ligaments are intact. The triangular fibrocartilage is intact. No TFC tear. 

Tendinosis of the extensor carpi ulnaris noted most pronounced at the level of the styloid process of the ulna. The remaining extensor tendons are without abnormality. The flexor tendons are intact. 

The carpal tunnel is preserved. No bowing of the retinaculum seen. 

The median nerve is normal in caliber and signal intensity. No evidence of entrapment. 

The muscles of the hand and wrist are intact without evidence of hemorrhage, tear or strain. 

A superficial cystic lesion is identified within the dorsal subcutaneous fat at the level of the distal ulnar metadiaphysis possibly representing an epidermoid inclusion cyst. 

CONCLUSION: 

1. Short-segment ECU tendinosis most pronounced at the level of the styloid process of the ulna. 

2. No TFC tear. 

3. Mild arthropathic changes of the capitate. 

4. Tiny, dorsal, subcutaneous cystic lesion at the level of the ulnar metadiaphysis, felt to be nonaggressive, most compatible with epidermoid inclusion cyst.

LESSON 3, TOPIC 60

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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