Wk 3, Case 3 - Review

Patient History
42-year-old male with right wrist pain with using wrist neutral or with any motion.

Findings

ALIGNMENT:

Ulnar Variance: Slightly positive.

Distal Radioulnar Joint: Incongruence of the distal radioulnar joint with dorsal and lateral tilting of the distal ulna which does not articulate with the sigmoid notch of the radius.

Carpal Instability: Dorsal tilting of the lunate.

ARTICULATIONS:

Thumb Carpometacarpal Joint: Mild osteoarthritis and chondromalacia with penetrating chondral fissures and intraosseous ganglion cysts within the hamate.

Scaphotrapeziotrapezoidal Joint: Moderate arthrosis and class 4 chondromalacia.

Pisiform-Triquetral Joint: Mild osteoarthritis.

Radiocarpal Joint: Normal.

Distal Radioulnar Joint: Moderate effusion of the distal radioulnar joint.

Carpal Effusion: Trace.

INTRINSIC LIGAMENTS:

Scapholunate Ligament: Swelling and nonconspicuity of the dorsal band of the scapholunate ligament and mild diastasis measuring up to 2mm in diameter.

Lunotriquetral Ligament: Normal.

Triangular Fibrocartilage: Central perforation of the disc proper. Diffuse swelling throughout the foveal and ulnar attachments of the triangular ligament.

Lunate Facet: Chondromalacia throughout the lunate with intraosseous ganglions at the level of the ulnocarpal joint.

Hamate-Lunate Facet: Normal.

Extensor Compartment: Short-segment diminutive split tear of the extensor carpi ulnaris, a few millimeters beyond the ulnar styloid and measuring up to 1cm in length. The rest of the extensor compartments are intact.

Flexor Compartment: Normal.

Carpal Tunnel: No space-occupying lesions.

Median Nerve: Normal signal. Vertical median nerve orientation as a variation between the flexor pollicis and flexor indicis.

Flexor Retinaculum: No thickening or scarring

Flexor Tendons: Normal.

Guyon's Canal: Normal.

OTHER FINDINGS:

Skeleton: No acute fractures or osteoedema.

Soft Tissues: No space-occupying lesions.

Vessels: Normal neurovascular bundles.

Impressions
1.Moderate scaphotrapezoidtrapezoidal joint osteoarthrosis with grade 4 chondromalacia and subchondral arthropathic cysts.
2.Dorsal radioulnar instability with subluxation and tearing of the dorsal radioulnar ligament.
3.A 1cm longitudinal split tear of the extensor carpi ulnaris, a few millimeters beyond the ulnar styloid.
4.Central perforation of the TFCC disc proper resulting in a small effusion of the distal radioulnar joint. Associated lunate chondromalacia. The findings are in keeping with a Palmer class 2C TFCC injury. Associated swelling of the triangular ligament.
5.Derangement of the dorsal scapholunate ligament resulting in 2mm diastasis and dorsal intercalated segmental instability (DISI).