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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.
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Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
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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.
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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
0:01
Axial protein density,
0:03
coronal and sagittal fluid sensitive images on a 68
0:08
year old woman who's presenting with wrist pain and instability.
0:13
On the axial images,
0:15
we see the distal radius and we find the equator of
0:20
the radial metaphysis By dividing the
0:25
sigmoid notch into an anterior and posterior half,
0:29
the creator of the distal radius should intersect the quitter of
0:34
the ulna and in this patient with distal radial ulnar instability,
0:40
the ulnar head is dorsally sub locks due to a
0:45
chronic tear of the palmar distal ready ulnar
0:50
ligament, which is clearly visualized on this image as well.
0:54
Coronal images allow us to assess the integrity of the triangular
0:59
fibrocartilage,
1:01
which in this case is the reason for the biomechanical
1:05
malalignment of the distal radial ulnar joint.
1:09
There is a complete tear of the triangular fibrocartilage with
1:14
fluid extending across the interval from the distal
1:19
radial ulnar joint into the radiocarpal joint.
1:22
There is already advanced osteoarthritis with bone and bone contact
1:27
of the distal radius with the ate and reactive mar edema.
1:32
T images allow us to assess the alignment of the distal
1:37
on and we clearly see the dorsal translation of the on
1:42
head in the setting.
1:44
Oft radio NAR joint instability.
Wk 5, Case 5 - Review
HIDEInteractive Transcript
0:01
Axial protein density,
0:03
coronal and sagittal fluid sensitive images on a 68
0:08
year old woman who's presenting with wrist pain and instability.
0:13
On the axial images,
0:15
we see the distal radius and we find the equator of
0:20
the radial metaphysis By dividing the
0:25
sigmoid notch into an anterior and posterior half,
0:29
the creator of the distal radius should intersect the quitter of
0:34
the ulna and in this patient with distal radial ulnar instability,
0:40
the ulnar head is dorsally sub locks due to a
0:45
chronic tear of the palmar distal ready ulnar
0:50
ligament, which is clearly visualized on this image as well.
0:54
Coronal images allow us to assess the integrity of the triangular
0:59
fibrocartilage,
1:01
which in this case is the reason for the biomechanical
1:05
malalignment of the distal radial ulnar joint.
1:09
There is a complete tear of the triangular fibrocartilage with
1:14
fluid extending across the interval from the distal
1:19
radial ulnar joint into the radiocarpal joint.
1:22
There is already advanced osteoarthritis with bone and bone contact
1:27
of the distal radius with the ate and reactive mar edema.
1:32
T images allow us to assess the alignment of the distal
1:37
on and we clearly see the dorsal translation of the on
1:42
head in the setting.
1:44
Oft radio NAR joint instability.
Report
Patient History
68-year-old female with right wrist pain with decreased mobility and strength.
Findings
ALIGNMENT:
Ulnar Variance: Slightly positive ulnar posture.
Distal Radioulnar Joint: Dorsal angulation of the distal ulna.
Carpal Instability: Unstable. See details below.
ARTICULATIONS:
Thumb Carpometacarpal Joint: Moderate osteoarthrosis with distal rupture of the anterior oblique/beak ligament with proximal retraction associated with radial subluxation of the 1st metacarpal base. The deltoid ligament is unaffected. Associated marginal osteophytes, chondromalacia and subchondral arthropathic cysts.
Scaphotrapeziotrapezoidal Joint: Diffuse chondromalacia and mild subchondral osteoedema.
Pisiform-Triquetral Joint: Mild chondromalacia and subchondral osteoedema.
Radiocarpal Joint: Diffuse chondromalacia with subchondral arthropathic cyst and diffuse osteoedema involving the ulnar side of the distal radial epiphysis and the entire lunate.
Distal Radioulnar Joint: Fluid distension of the distal radioulnar joint.
Carpal Effusion: Small joint effusion, mainly at the radial side.
INTRINSIC LIGAMENTS:
Scapholunate Ligament: Intact.
Lunotriquetral Ligament: Limited visualization. Suspect chronic tear.
Triangular Fibrocartilage: Complex fraying and tear/perforation of the central disc. The ulnar and foveal styloid attachments demonstrate diffuse swelling and are inconspicuous. Diffuse swelling throughout the meniscus homologous. Suspect longstanding ulnolunate abutment syndrome Palmer 2 C-D
Lunate Facet: Generalized chondromalacia, subchondral arthropathic cysts and diffuse osteoedema throughout.
Extensor Compartment: Stripping of the ulnar attachment of the extensor carpi ulnaris (ECU) subsheath with partial ulnar subluxation of the ECU. The extensor retinaculum is intact. Rest of the extensor tendons are noncontributory.
Flexor Compartment:
Carpal Tunnel: No space-occupying lesions.
Median Nerve: Normal diameter and signal intensity.
Flexor Retinaculum: No thickening or palmar bowing.
Flexor Tendons: No tears or tenosynovitis.
Guyon's Canal: No space-occupying lesions.
OTHER FINDINGS:
Skeleton: Diffuse capsulosynovial soft tissue swelling involving the dorsal intercarpal and palmar radioscaphocapitate extrinsic ligaments.
Soft Tissues: As described.
Vessels: Normal.
Impressions
1.Distal radioulnar joint instability with tearing of the volar radioulnar ligament and dorsal angulation of the distal ulna.
2.Findings result in generalized radiocarpal, ulnar and triquetral chondromalacia with subchondral arthropathic cysts and moderate to severe confluent osteoedema throughout the distal radial epiphysis, the entire lunate and to a lesser degree within the triquetrum.
3.Complex tear of the TFC disc central third, with swelling of its ulnar foveal and styloid attachments and the meniscus homologous.
4.Small joint effusion of the distal radioulnar joint.
5.Diffuse capsulosynovial swelling involving the dorsal and volar extrinsic wrist ligaments and a small intercarpal joint effusion.
6.Conglomerate of findings favor mechanical arthrosis over a primary inflammatory (rheumatoid) arthritis.
7.Ulnolunate abutment syndrome Palmer 2 C-D. Lunatotriquetral ligament status in question.
8.Ulnar side stripping of the ECU subsheath with mild subluxation. The extensor retinaculum is intact.
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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