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8b - Answer: 68-year-old male presents with ulnar-sided left wrist pain

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

HISTORY: 

This 68-year-old male presents with ulnar-sided left wrist pain. Patient was carrying baggage and twisted his wrist two months prior.

(QUIZ ANSWER) PRIMARY FINDING IN THIS CASE: 

Lunatotriquetral ligament tear.

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

FINDINGS:

Extensive arthropathic and erosive change in the lunate with overlying areas of complex lunatomalacia and lesser degrees of ulnar cartilage thinning and ulnomalacia are noted. 

The triangular fibrocartilage is surprisingly of normal thickness and no macroscopic vertical tear is identified with only the tiniest fenestrations visible. 

At first glance, the diagnosis of ulnolunate abutment syndrome with TFC disease class II D was presumed but in the absence of a TFC tear more likely, the patient has suffered a lunatotriquetral ligament rupture with resultant micro- or macroinstability leading to arthrosis of the lunate. A chronic split tear of the ECU is little inflamed and therefore may be partially healed. Surrounding swelling is nominal at best. 

Chondromalacia of the radial side of the radioulnar articulation is noted. 

The scapholunate ligament is normal. 

Mild posterior displacement of the ulna is present which may be positional or related to insufficiency of the radioulnar ligament. The ligament is identified. 

CONCLUSION: 

Lunatotriquetral ligament tear with resultant sequela as described in the body of the report.

LESSON 2, TOPIC 24

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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