24b - Answer: 59-year-old male presents with mild dull pain when pushing on right wrist
HISTORY:
This 59-year-old male presents with mild dull pain when pushing on right wrist for nine months since work injury. Numbness and weakness in right hand.
(QUIZ ANSWER) UNDER WHICH PALMER CLASSIFICATION:
Palmer classification 2C.
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. A neutral ulnar variance. Triangular fibrocartilage macerated. Mild stress osseous edema of distal radius and ulna. Focal osteochondral erosion with mild stress edema of the lunate, ulnomalacia. Small foci of osseous erosion with subtle stress osseous edema in the scaphoid, triquetrum and hamate. The carpal bones normal in alignment. No acute sprain of scapholunate or lunotriquetral ligaments.
Mild spurring in the 1st carpometacarpal articulation.
Laxity / inflammation of SL interval without ligamentous tear.
Extensor tendons 1 through 5 intact. Mild tendinopathy of extensor carpi ulnaris, no tear. Flexor tendons intact. Median nerve normal in caliber.
No acute muscle strain.
Moderate amount of fluid within the 2nd and 3rd extensor tendon sheaths.
IMPRESSION:
Right Wrist: Chronic ulnocarpal abutment with macerated triangular fibrocartilage and osteochondral erosion of the lunate, ulnomalacia. Palmer classification 2C (LT ligament intact).
Chronic radiocarpal and mid carpal arthrosis with mild stress osseous edema and foci of osteochondral erosion.
Mild arthrosis of 1st carpometacarpal articulation with spurring.
Laxity / inflammation of SL interval without ligamentous tear.
Peritendinitis of 2nd and 3rd extensor tendons with moderate amount of fluid in the tendon sheaths.
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Content reviewed: September 28, 2021