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1b - Answer: 35-year-old female presents with pain shooting to right fingers

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

HISTORY:

This 35-year-old female presents with pain shooting to right fingers for approximately one month.

(QUIZ ANSWER) NOT A LIKELY DIAGNOSIS IN THIS CASE:

Extensor carpi ulnaris radial-sided subsheath tear.

Using the diagnostic web viewer, we have located some key images that assist in telling our clinical story. Areas of significance have been highlighted below.

FINDINGS:

No fracture or abnormal marrow edema. Small intraosseous ganglion in the capitate.

No radiocarpal, ulnocarpal, intercarpal or 1st carpometacarpal chondromalacia.

Triangular fibrocartilage (TFC) and its attachments are intact, with an incidental TFC fenestration.

Extensor carpi ulnaris tendon is partially subluxed ulnarward from its groove in the ulna, consistent with an ulnar-sided subsheath tear. Interstitial concealed tears and tendinopathy of the extensor carpi ulnaris at the level of the wrist joint.

Minimal fluid in the 2nd extensor compartment but otherwise extensor tendons are intact. Flexor tendons are intact.

Small effusion at the triquetropisiform joint, which is not uncommon.

Extrinsic dorsal and volar ligaments are intact. Scapholunate and lunotriquetral ligaments are intact.

CONCLUSION:

Interstitial concealed tears and tendinopathy of the extensor carpi ulnaris tendon where it is mildly subluxed ulnarward from its groove on the ulna, consistent with an ulnar-sided subsheath tear.

LESSON 2, TOPIC 3

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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