Wk 1, Case 3 - Review

Patient History
67-year-old male with constant, moderate and dull pain in the left hand with difficulty lifting or using hand.

Findings

ALIGNMENT:
Ulnar Variance: Neutral.

Distal Radioulnar Joint: Normal.

Carpal Instability: None.

ARTICULATIONS:
Thumb Carpometacarpal Joint: Normal.

Scaphotrapeziotrapezoidal Joint: Normal.

Pisiform-Triquetral Joint: Normal.

Radiocarpal Joint: Normal.

Distal Radioulnar Joint: Normal.

Fluid: None.

Carpal Effusion: None.

Distal Radioulnar Joint Effusion: None.

INTRINSIC LIGAMENTS:
Scapholunate Ligament: Intact.

Lunotriquetral Ligament: Intact.

Triangular Fibrocartilage: Intact.

Lunate Facet: Normal.

Hamate-Lunate Facet: Normal.

Extensor Compartment: No tendinosis, tenosynovitis or tendon tears. Flexor Compartment: No tendinosis, tenosynovitis or tendon tears. Carpal Tunnel: No space-occupying lesions.

Median Nerve: Normal signal.

Flexor Retinaculum: No thickening or volar bowing.

Flexor Tendons: No tendinosis, tenosynovitis or tendon tears. Guyon's Canal: Soft tissue edema.

OTHER FINDINGS:
Skeleton: Minimally displaced fracture at the ulnar side of the distal hamate body with diffuse osteoedema extending throughout the hamate body and hook. The hamate hook is intact.

Transverse nondisplaced fracture throughout the 4th metacarpal base associated with osteoedema. Oblique nondisplaced fracture through the radial side of the 5th metacarpal base with diffuse osteoedema.

Soft Tissues: Focal soft tissue edema in the Guyon's (ulnar) canal and involving the flexor digiti minimi brevis, opponens digiti minimi and abductor digiti minimi.
Vessels: Normal.

Impressions
1. High-grade impaction injury to the hypothenar side of the wrist resulting in a minimally avulsed fracture through the ulnar side of the distal hamate body involving the 4th and 5th carpometacarpal joints; a nondisplaced transverse fracture through the 4th metacarpal base and an oblique nondisplaced fracture through the radial side of the 5th metacarpal base.
2. Diffuse soft tissue edema throughout the hypothenar region involving the Guyon's canal.