This 46-year-old male presents with left wrist pain, swelling, and stiffness.
(QUIZ ANSWER) A LIKELY DIFFERENTIAL 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.
Bones about the wrist demonstrate expected alignment. No evidence for occult fracture or contusion. Subtle scattered areas of marrow edema with small pseudocysts within the capitate and lunate. Focal erosions along the pisiform and trapezium. There is subtle abnormality involving the trapezoid and favor a secondary accessory ossicle over remote fracture.
Scapholunate and lunotriquetral ligaments are grossly intact. Triangular fibrocartilage complex is intact without evidence of TFC tear.
The tendons about the wrist are intact without evidence of high-grade tendinosis or tear. Mild synovitis of the extensor tendons at the level of the wrist. Diffuse synovitis is visualized throughout the wrist joint with areas of synovial thickening. Carpal tunnel is unremarkable without evidence of median nerve edema.
No evidence of mass, cyst or occult carpal ganglion. No high-grade soft tissue inflammation or edema.
1. Multiple erosions with marrow edema with surrounding synovitis of the wrist most suggestive of an inflammatory arthropathy such as CPPD, gout or rheumatoid arthritis.
2. Degeneration of the triquetral limb of the LT or lunotriquetral ligament.
3. Favor an accessory ossicle in the region of the trapezoid over remote nonunited trapezoid fracture.
4. Severely and diffusely atrophic extensor carpi ulnaris tendon with suggestion of splits, old and unrelated to crystal disease or RA.
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Content reviewed: September 28, 2021