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

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

HISTORY: 

This 21-year-old female presents with palmar right wrist pain over the carpal tunnel region after falling off porch one month prior.

(QUIZ ANSWER) PRIMARY FINDING: 

Scapholunate ligament tear.

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

FINDINGS: 

Partial thickness, scapholunate ligamentous tear involving all components, with widening of scapholunate interval up to 4mm.

No volar rotatory scaphoid subluxation, with normal scapholunate angle of 45 degrees. No dorsal intercalated segment instability, with normal capitolunate angle of 0 degrees.

Intact lunatotriquetral ligament.

Tiny hamate bone island or involuted penetrating intraosseous ganglion.

Carpal tunnel, including flexor tendons and median nerve, is normal.

Guyon's canal, including ulnar nerve, is normal.

Extensor compartments and their contents are normal.

Intact triangular fibrocartilage complex.

Small wrist and distal radioulnar joint effusions.

No fracture or soft tissue mass.

CONCLUSION:

Partial thickness, scapholunate ligamentous tear, involving all components, with widening of scapholunate interval, but no volar rotatory scaphoid subluxation, scaphoid fracture or dorsal intercalated segment instability. Clinical Geissler 2 classification is suspected. Steep radial and ulnar plain radiographs of the wrist are requested to assess severity of dynamic instability.

LESSON 3, TOPIC 72

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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