Wk 10, Case 5, Hand/Wrist MR - Review

Patient History

68M posterior wrist pain with numbness in middle finger. No surgery and no injury.

Findings

ALIGNMENT:

Ulnar Variance: Slight negative ulnar variance posture.

Distal Radioulnar Joint: Normal.

Carpal Instability: Unstable.

ARTICULATIONS:

Thumb Carpometacarpal Joint: Severe osteoarthrosis with marginal osteophyte spurring and radial subluxation of the metacarpal base. Chronic injuries to the anterior oblique ligament, the dorsal radial, dorsal central and posterior oblique ligaments. Moderate capsulitis with synovitis.

Scaphotrapeziotrapezoidal Joint: Moderate to severe osteoarthrosis with osteophyte spurring.

Pisiform-Triquetral Joint: Moderate osteoarthrosis.

Radiocarpal Joint: Osteophyte spurring involving the radial styloid, the articular and non articular surfaces of the scaphoid, the entire radio scaphoid joint and associated with proximal migration of the capitate; severe narrowing of the capitolunate with chondromalacia and large arthropathic cysts in the proximal capitate and early ulnar displacement of the lunate.

Scapholunate diastasis with the interval measuring 8 mm in width.

Dorsal tilt of the lunate with radiolunate angle measuring 127º (normal <10º).

Scaphoid rotatory subluxation with dorsal migration of the proximal pole and radio scaphoid with angle of 135º (normal <60º).

Carpal Effusion: Moderate joint effusion with diffuse synovitis.

Distal Radioulnar Joint Effusion: Small.

INTRINSIC LIGAMENTS:

Scapholunate Ligament: Chronic appearing full-thickness tear with associated diastasis as described.

Lunotriquetral Ligament: Intact.

Triangular Fibrocartilage: Fraying of the disc proper. The foveal and styloid laminae and meniscus homologous are intact.

Lunate Facet: Normal.

Hamate-Lunate Facet: Normal.

Extensor Compartment:

I: Normal.

II: Normal.

III: Normal.

IV: Normal.

V: Normal.

VI: Chronic injury to the extensor carpi ulnaris (ECU) subsheath which is scarred. The ECU is subluxed ulnarly and overlies the ulnar styloid. Associated tenosynovitis.

Flexor Compartment: Prominent tenosynovitis of the flexor carpi radialis (FCR) and to a lesser degree of the flexor pollicis longus (FPL).

Carpal Tunnel: Septated ganglion pseudocyst dissecting deep to the flexor digitorum profundus (FDP) and measuring 0.5 cm x 0.8 cm x 2 cm (AP, transverse and CC)

Median Nerve: Normal.

Flexor Tendons: As described.

Guyon's Canal: Normal. No space-occupying lesions.

OTHER FINDINGS:

Skeleton: No fractures or dislocations.

Soft Tissues: Diffuse periarticular soft tissue swelling. No space-occupying lesions.

Vessels: Normal

Impressions

1. Chronic appearing full-thickness tear of the scapholunate ligament with associated diastasis. Pointed hypertrophic radial styloid. Constellation of findings in totality compatible with slac wrist or scapholunate advanced collapse.

2. Scapholunate diastasis with rotatory subluxation of the scaphoid and dorsal intercalated segmental instability (DISI) resulting in generalized osteoarthrosis of the radioscaphoid and the capitolunate joints with early proximal capitate migration.

3. Chronic injury to the extensor carpi ulnaris (ECU) subsheath with ECU subluxation and tenosynovitis.

4. Prominent tenosynovitis of the flexor carpi radialis (FCR) and to a lesser degree of the flexor pollicis longus (FPL).

5. Moderate joint effusion with diffuse synovitis.

6. Additional findings as described.