7b - Answer: 58-year-old female presents with mild pain in right wrist
HISTORY:
This 58-year-old female presents with mild pain in right wrist from lifting heavy objects at work about a month ago, worse with using fingers or lifting; weakness and swelling in wrist.
(QUIZ ANSWER) NOT A FINDING IN THIS CASE:
Minuscule interstitial tear of the extensor pollicis longus.
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 or contusion. Dorsal deviation of the distal ulna with chronic tear of volar radioulnar ligament. Severe capsular inflammation in the radioulnar joint. A tear of the triangular fibrocartilage near the radius. Stress osseous edema and subtle erosion of distal ulna including ulnar styloid. Scapholunate and lunatotriquetral ligaments intact. Mild stress edema in the lunate and triquetrum. Small focus of subcortical pseudocyst formation in the distal lunate at scapholunate articulation. Foci of stress-related fibrocystic change in the capitate. The carpal bones normal in alignment.
Extensor tendons 1-5 intact. A minuscule interstitial tear of the extensor carpi ulnaris by the ulnar styloid. Flexor tendons intact. No acute muscle strain.
Mild-moderate dorsal midcarpal capsular inflammation.
IMPRESSION:
Right Wrist: Chronic distal radioulnar instability with capsulitis, tear of volar radioulnar ligament and stress-related fibrocystic change in the distal ulna.
Chronic ulnocarpal abutment with subtle erosion of the lunate and tear of the triangular fibrocartilage. Mild stress edema of the triquetrum. Palmer classification 2C.
Small focus of subcortical pseudocyst formation of distal lunate and fibrocystic change of the capitate, osteoarthritic etiology.
Mild-moderate dorsal midcarpal capsulitis.
Minuscule chronic interstitial tear of extensor carpi ulnaris by the ulnar styloid.
Case Challenge: Wrist MRI Cases
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Content reviewed: September 28, 2021