2b - Answer: 15-year-old female gymnast presents with pain of right wrist
HISTORY:
This 15-year-old female gymnast presents with pain at the Luno-Triquetral (LT) and triangular fibrocartilage complex (TFCC) region of the right wrist.
(QUIZ ANSWER) PRIMARY FINDING IN THIS CASE:
Ganglion.
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:
Skeletal: No acute fracture, microfracture or osseous contusion. No advanced arthropathic change, prominent erosive/cystic change or osteochondral lesion.
Ligaments: Scapholunate and lunotriquetral ligaments intact. Intact dorsal radiolunatotriquetral and intercarpal ligaments.
Extensor Group Tendons: Preserved signal intensity without peritendinosis or tenosynovitis.
Flexor Tendon / Carpal Tunnel / Nerves: Carpal tunnel is preserved. No bowing of the retinaculum seen. Flexor tendons are intact. Median nerve is normal in caliber and signal intensity. No evidence of ulnar nerve entrapment within Guyon's canal or signal abnormality of the dorsal radioulnar joint and the first CMC joint.
TFCC: Normal thickness and signal with normal attachment to the ulna lunate complex, ulnar styloid and fovea, and ECU sub-sheath. No TFC tear.
Volar ganglion is identified deep to the carpal tunnel situated between the base of the 2nd and 3rd metacarpals and interspace between the hamate and capitate. No focal erosions. This is at the site of pain.
CONCLUSION:
1. Ganglion distorts the deep and ulnar side of the carpal tunnel at the level of the hamate hook.
2. Nominal induration within the dorsal extrinsic inter-carpal ligaments. No joint space inflammation. Normal TFCC. Normal extensor and flexor tendons.
Case Challenge: Wrist MRI Cases
Case Challenge
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Content reviewed: September 28, 2021