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

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

HISTORY: 

This 53-year-old male presents with moderate to severe, sharp and dull, right wrist pain and swelling for a year. It is worse when using hand and lifting objects. History of cortisone injection.

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

All of the above.

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

FINDINGS:

Intraosseous pseudocyst in the ulnar styloid with moderate to severe stress edema in the distal ulna. No acute bony macrofracture. A thin pinhole tear of the triangular fibrocartilage near the radius. Focal erosion in the lunate. Scapholunate and lunotriquetral ligaments intact. Small area of fibrocystic change in the triquetrum. Carpal bones normal in alignment. 

Extensor tendons I-V intact. Moderate peritendinitis of the extensor carpi ulnaris with mild tendinopathy and 3 cm interstitial tear. Flexor tendons intact. Median nerve normal in caliber. 

IMPRESSION:

Right Wrist: Severe stress-related fibrocystic change and osseous edema of distal ulna epicentered at the ulnar styloid. 

Peritendinitis of extensor carpi ulnaris with mild tendinopathy and 3 cm split tear epicentered around the ulnar styloid. 

Ulnocarpal abutment with a thin pinhole tear of the triangular fibrocartilage and focal erosion of the lunate, Palmer classification IIC.

LESSON 2, TOPIC 36

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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