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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
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Start Here
Start Here
3 topics, 3 min. of video
Practice Cases
Week 1
6 topics, 27 min. of video
Practice Cases
Week 2
7 topics, 11 min. of video
Practice Cases
Week 3
6 topics, 17 min. of video
Practice Cases
Week 4
6 topics, 15 min. of video
Practice Cases
Week 5
7 topics, 9 min. of video
End of Course Activities
Course Evaluation
1 topic
0:00
This is a 62 year old man who has history of pain at the base of thumb
0:05
articulation, coronal, ster, and coronal.
0:09
T one weighted images demonstrate end stage osteoarthritis at the first
0:14
carpal metacarpal joint with marked loss of articular cartilage
0:18
and near vulnerable contact of the subcontract plates across the articulation.
0:25
Very important to assess the integrity of the ligaments at
0:30
the first C M C joint where we see advanced osteoarthritis.
0:33
So we have the anterior oblique ligament also turn the big ligament,
0:37
which in this patient, um, we, uh,
0:41
have big osteophytes at the attachment of the anterior oblique ligament
0:46
that go along with the, um,
0:48
setting of osteoarthritis and first carpal metacarpal instability.
0:53
In assessing the ligament,
0:55
we go to the palmar surface and we see that there is discontinuity
1:00
of the fibers at the insertion into the trapezium. Uh,
1:03
so this patient has a chronic tear of the big ligament of the
1:08
anterior of ligament, assessing the delta ligament.
1:12
We see also osteophytes at the base of the first metacarpal in that location,
1:17
some reactive antipathy at the insertion of the delta
1:22
ligament,
1:22
and marked thickening of the fibers contributing to the presence of
1:27
radial subluxation of the first metacarpal base on the trapes
1:32
in this patient with end stage osteoarthritis.
Wk 3, Case 2 - Review
HIDEInteractive Transcript
0:00
This is a 62 year old man who has history of pain at the base of thumb
0:05
articulation, coronal, ster, and coronal.
0:09
T one weighted images demonstrate end stage osteoarthritis at the first
0:14
carpal metacarpal joint with marked loss of articular cartilage
0:18
and near vulnerable contact of the subcontract plates across the articulation.
0:25
Very important to assess the integrity of the ligaments at
0:30
the first C M C joint where we see advanced osteoarthritis.
0:33
So we have the anterior oblique ligament also turn the big ligament,
0:37
which in this patient, um, we, uh,
0:41
have big osteophytes at the attachment of the anterior oblique ligament
0:46
that go along with the, um,
0:48
setting of osteoarthritis and first carpal metacarpal instability.
0:53
In assessing the ligament,
0:55
we go to the palmar surface and we see that there is discontinuity
1:00
of the fibers at the insertion into the trapezium. Uh,
1:03
so this patient has a chronic tear of the big ligament of the
1:08
anterior of ligament, assessing the delta ligament.
1:12
We see also osteophytes at the base of the first metacarpal in that location,
1:17
some reactive antipathy at the insertion of the delta
1:22
ligament,
1:22
and marked thickening of the fibers contributing to the presence of
1:27
radial subluxation of the first metacarpal base on the trapes
1:32
in this patient with end stage osteoarthritis.
Report
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.
Case Discussion
Faculty
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Jenny T Bencardino, MD
Vice-Chair, Academic Affairs Department of Radiology
Montefiore Radiology
Todd D. Greenberg, MD
Radiologist
ProScan
Tags
Musculoskeletal (MSK)
MRI
Hand & Wrist
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