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16b - Answer: 43-year-old male presents with right wrist pain, and right thumb numbness

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

HISTORY: 

This 43-year-old male presents with right wrist pain, and right thumb numbness, since injury at work one month prior. Pain is worse when lifting objects.

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

Extensor carpi ulnaris (ECU) tear.

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

FINDINGS:

No acute bony macrofracture or contusion. Negative ulnar variance within normal limits. No triangular fibrocartilage tear. Moderate inflammation of the peripheral attachment. 

Chronic mild swelling of scapholunate ligament with small foci of osteochondral erosion of the scaphoid and the lunate. Lunotriquetral ligament intact. Focal osteochondral erosion of the proximal hamate. 

Moderate-severe fusiform hypertrophic tendinopathy of first extensor tendon group with discrete focal communicating tear including a split component, length 1.5cm. Moderate-severe tendinopathy of extensor carpi ulnaris by the ulnar styloid with an interstitial laminar tear. Flexor tendons intact. Median nerve normal in size and signal intensity. 

No acute muscle strain. 

IMPRESSION:

Right Wrist: Moderate-severe tendinopathy of first extensor tendon group with discrete focal communicating tear including a split component, length 1.5cm. Focal moderate-severe tendinopathy of extensor carpi ulnaris by the ulnar styloid with a thin interstitial laminar tear. 

Chronic moderate scapholunate arthrosis with small foci of osteochondral erosion and swelling of the scapholunate ligament. Focal osteochondral erosion of proximal hamate.

LESSON 2, TOPIC 48

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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