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19b - Answer: 32-year-old male presents with volar right wrist swelling

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

HISTORY: 

This 32-year-old male presents with volar right wrist swelling, flexor tenosynovitis versus atypical ganglion. Swelling since 13 years old, with numbness.

(QUIZ ANSWER) ACCESSORY MUSCLE IN THIS CASE: 

Accessory digiti minimi.

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

FINDINGS:

An accessory muscle is seen in the forearm just lateral to the palmaris longus and then tracks towards the ulnar side of the wrist subtly compresses the structures of the tunnel of Guyon's canal and proceeds deep in the hypothenar eminence. The exact locus of attachment could not be seen as it went off the screen, but an accessory abductor digiti minimi or other digiti minimi accessory muscle is strongly favored. The median nerve is unencumbered. 

No signs of ulnovascular thrombosis are present. 

The course is inconsistent with a muscular palmaris longus. 

The muscle is very superficially located before it dives into the hypothenar eminence, and especially at the level of proximal Guyon's canal is likely palpable. 

CONCLUSION: 

Accessory digiti minimi muscle most likely abductor digiti minimi. Minimal swelling along the floor or proximal surface of the TFC and along its peripheral attachments are noted.

LESSON 2, TOPIC 57

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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