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15b - Answer: 60-year-old female presents with ulnar-sided pain in right wrist

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

HISTORY: 

This 60-year-old female presents with ulnar-sided pain in right wrist. Failed splinting. Pain is with ulnar deviation or with shucking of the distal radioulnar joint. A subchondral cyst along the lunate was described on an x-ray.

(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:

Ulnocarpal abutment syndrome with lunate erosion and lunato-chondromalacia, ulno-chondromalacia, and a TFC central third tear is noted. 

Fluid in the distal radioulnar joint. 

Inflamed peripheral attachments. 

The lunatotriquetral ligament is intact. 

Incidentally noted is an accessory peroneus quartus seen. 

The palmar attachments of the TFC are diffusely inflamed especially the proximal ones. 

Diffuse peripheral synovitis of the TFCC. 

CONCLUSION: 

1. Palmer class 2C ulnolunate abutment syndrome and TFCC tear with lunato-chondromalacia and ulno-chondromalacia. LT ligament degenerated and inflamed but intact. 

2. Small ganglion pseudocyst or capsular cyst at the scaphomultangular articulation. 

3. Mild 1st CMC arthrosis.

LESSON 2, TOPIC 45

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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