Wk 3, Case 2 - Review

Patient History
62-year-old female with history of right ulnar-sided cyst, status post multiple drainage procedures.

Findings

ALIGNMENT:

Ulnar Variance: Neutral ulnar variance position.

Distal Radioulnar Joint: Normal.

Carpal Instability: None.

ARTICULATIONS:

Thumb Carpometacarpal Joint: Dorsoradial subluxation of the 1st carpometacarpal joint associated with volar, beak-like osteophytes involving the 1st metacarpal base and ulnar side of the trapezium. Laxity and discontinuity of the anterior oblique (“beak”) ligament (AOL) which is discontinuous and retracted distally. Laxity of the radial side deltoid ligament. Generalized chondromalacia with subchondral arthropathic cysts and mild capsulitis.

Scaphotrapeziotrapezoidal Joint: Mild osteoarthritis.

Pisiform-Triquetral Joint: Normal.

Radiocarpal Joint: Normal.

Distal Radioulnar Joint: Normal.

Carpal Effusion: Nominal.

Distal Radioulnar Joint Effusion: Mild fluid distention.

INTRINSIC LIGAMENTS:

Scapholunate Ligament: Intact.

Lunotriquetral Ligament: Intact.

Triangular Fibrocartilage: Complex chronic tear of the TFCC disc proper. Associated chondromalacia and subchondral cyst formation of the lunate and triquetrum. Diffuse edema and inconspicuous signal of the triangular ligament (ligamentum subcruentum) involving its foveal and styloid attachments as well as the meniscus homologous portion.

Lunate Facet: Diffuse chondromalacia.

Extensor Compartment: No tears or tendinopathy.

Flexor Compartment: No tears or tendinopathy.

Carpal Tunnel: No space-occupying lesions. Normal flexor retinaculum.

Median Nerve: Mild increased diameter with normal signal.

Flexor Retinaculum: No thickening or scarring

Flexor Tendons: No tears or tendinopathy.

Guyon's Canal: Normal.

OTHER FINDINGS:

Vessels: Normal neurovascular bundle.

Impressions
1.Suggestion of ulnar impaction syndrome resulting in complex chronic tear of the TFCC disc, associated lunotriquetral chondromalacia and complex sprain of the triangular ligament and meniscus homologous (TFCC Palmer class IIA).
2.Severe osteoarthrosis of the thumb CMC joint with dorsoradial subluxation, injury to the AOL and laxity of the radial side deltoid ligament.