Patient History
21-year-old female with right anterior wrist pain, weakness, tingling and numbness, which began approximately 1 month ago. No known injury. Patient has a history of prior surgery 3 years ago when she had a cyst removed.
Findings
ALIGNMENT:
Ulnar Variance: Negative ulnar posture.
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.
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 tendinopathy or tears.
Flexor Compartment: No tendinopathy or tears.
Carpal Tunnel: No space-occupying lesions.
Median Nerve: Normal signal and diameter.
Flexor Retinaculum: No thickening or palmar bowing.
Flexor Tendons: No tendinopathy or tears.
Guyon's Canal: A 2.8 cm x 3.1 cm x 6.1 cm (AP, transverse and CC diameters) ulnar-sided encapsulated lipoma with thin internal septations is located in the palmar ulnar side of the wrist, spanning the distal forearm, wrist and down into the Guyon canal.
OTHER FINDINGS:
Skeleton: No fracture or dislocations.
Soft Tissues: Thenar and hypothenar muscles are normal without fatty infiltration or volumetric atrophy. The interossei and lumbricals are also normal.
Vessels: Normal.
Impressions
1.A large 2.8 cm x 3.1 cm x 6.1 cm encapsulated fat signal mass in the palmar, ulnar aspect spanning the distal forearm, wrist and Guyon canal, producing mass effect and compressing the superficial sensory and deep motor branches of the palmar division of the ulnar nerve. No fatty infiltration or volumetric atrophy denervation of the hypothenar, interossei and lumbrical muscles at this moment. Findings most compatible with a lipoma. Complex septations may be seen in atypical lipomatous tumors so called ALT.
