Wk 3, Case 4 - Review

Patient History
58-year-old female complaining of right posterior hand pain. History of carpal tunnel surgery on 11/24/2020.

Findings

ALIGNMENT:

Ulnar Variance: Neutral.


Distal Radioulnar Joint: Normal.

Carpal Instability: Normal.

ARTICULATIONS:

Thumb Carpometacarpal Joint: Moderate osteoarthrosis with a scarred and chronically torn anterior oblique ligament and mild dorsoradial subluxation of the 1st metacarpal base.

Scaphotrapeziotrapezoidal Joint: Normal.

Pisiform-Triquetral Joint: Normal.

Radiocarpal Joint: Trace amount of fluid.

Distal Radioulnar Joint: Small joint effusion.

Carpal Effusion: Trace amount of effusion.

INTRINSIC LIGAMENTS:

Scapholunate Ligament: Intact.

Lunotriquetral Ligament: Intact.

Triangular Fibrocartilage: Tiny tear of the central portion of the disc proper.

Lunate Facet: Normal.

Hamate-Lunate Facet: Normal.

Extensor Compartment: Nominal tenosynovitis throughout. No tendon tears.

Flexor Compartment: Mild to moderate tenosynovitis.


Carpal Tunnel: Previous release of the flexor retinaculum.

Median Nerve: Focal, abrupt signal change with increased T2 signal of the median nerve extending for a length of 6 mm and located at the level of the flexor retinaculum release. Palmar bowing of the median nerve and the fibrofatty cleft created by the release is common after median nerve surgery.

Guyon's Canal: No space-occupying lesions.

OTHER FINDINGS:
Skeleton: Biomechanical arthropathic intraosseous cysts within the proximal aspect of the capitate.

Soft Tissues: Unremarkable thenar and hypothenar eminences.

Vessels: Noncontributory.

Impressions
1.Previous carpal tunnel release. A thickened and focal abrupt T2 signal increase of the median nerve at the level of the flexor retinaculum release raising suspicion for focal laceration and neuritis. This abnormal signal extends for a length of 6 mm.
2.Mild to moderate flexor tenosynovitis. Nominal extensor tenosynovitis
3.Suspicion of a central tiny perforation of the TFC disc proper with a small distal radioulnar joint effusion.
4.Small radiocarpal and carpal joint effusion.