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17b - Answer: 62-year-old male presents with possible scapholunate injury

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

HISTORY: 

This 62-year-old male presents with possible scapholunate injury or tear in the left wrist.

(QUIZ ANSWER) INSTABILITY NOT IN THIS CASE: 

Rupture of the lunatotriquetral ligament.

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

FINDINGS:

Scapholunate ligament rupture with proximal migration of the capitate and ulnar translocation of the lunate is noted. Attenuated appearance of the lunatotriquetral ligament although, intact. Inner third of the triangular fibrocartilage is torn, Palmer 1A. TFCC peripheral, distal and proximal attachments are intact. 

Extensive effusion throughout the wrist with osteoarthritic changes at the capitolunate, lunatotriquetral and especially the first CMC are noted. 

Favor mechanical arthrosis with secondary osteoarthritis and the early development of SLAC wrist as there is remodeling of the scaphoid fossa. The lunate is assuming an early DISI posture. The scaphoid demonstrates rotatory displacement compatible with insufficiency or tear of the radioscaphocapitate ligament. 

The extensor carpi ulnaris is intact. 

The ulna floats dorsally consistent with laxity of the volar radioulnar ligament. 

CONCLUSION: 

Multiple instabilities including rupture of the scapholunate ligament, insufficiency of the volar radioulnar ligament, insufficiency of the radioscaphocapitate ligament, early SLAC wrist, and a myriad of other positional abnormalities described in the body of the report.

LESSON 2, TOPIC 51

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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