0:00

<v ->And this is a typical case of rheumatoid arthritis.

0:05

So this is a 61 year old female patient.

0:09

Is it correct, your favorite joint is wrist?

0:13

<v ->Yes

0:14

Okay, so the next two cases, it is about wrist

0:19

so it will make you feel happy.

0:22

(both laugh)

0:23

So this case is a case of history

0:29

of 61 year old female patient.

0:31

History of rheumatoid arthritis for 10 years.

0:36

And right out of the gate we can see the effects

0:40

of the chronic synovitis compromising the wrist.

0:43

We can see the joint fusion.

0:45

We can see the chronic synovitis in many areas.

0:51

Let me put the post construct, the contrast image here.

0:55

We can see the synovitis.

0:59

We can see the bone marrow edema.

1:01

We can see many areas of bone erosions

1:06

in many locations here.

1:07

You can see in this case that the disease

1:09

is compromising mainly the distal radioulnar joint

1:14

and the radiocarpal joint here.

1:20

And one point that I'd like to emphasize in this case

1:26

is the styloid process of the ulnar.

1:30

The ulnar styloid process.

1:31

Look how the ulnar styloid process is irregular.

1:36

We have, there is edema in this area

1:39

and as Dr. Resnick said in his previous lecture

1:46

this area is very vulnerable to synovitis

1:50

because we have the tendon shift

1:53

of the extensor carpi ulnaris.

1:56

We have the pre-styloid recess right here,

1:59

and there is also the radial,

2:02

distal radioulnar articulation here.

2:05

So it's a very vulnerable area

2:11

when the patient has chronic synovitis.

2:13

Look here, the bone erosion

2:16

of the ulnar styloid here in this region.

2:21

So that's a very interesting

2:24

a very illustrative case of the repercussions

2:30

of a patient with rheumatoid arthritis.

2:33

Another thing that I'd like to show you in this case

2:38

is the bone cyst.

2:41

Patients with rheumatoid arthritis

2:45

they are prone to, of course, with this huge bone cyst.

2:50

And we can see that better in the statial plane here.

2:55

You can see a bone cyst in the ulnar portion

2:59

of the distal radius.

3:02

And this cyst, it is filled with fluid

3:06

and also with inflammatory synovial tissue.

3:10

And we can see that very well.

3:12

This patient also has other lesions

3:15

like complete tear of the TFCC.

3:20

And also complete tear of the scapholunate ligament.

3:26

We have many other lesions going on in this case.

3:30

Let me see if I have something,

3:32

something more to... ah!

3:35

One thing that I like,

3:38

it's not really related to the disease

3:42

but one thing that I like sometimes

3:44

that we have to get the case that we are reporting,

3:50

that we are reading,

3:51

and we have to take everything of this case.

3:55

And sometimes because of the disease, because of the fluid

4:00

because of the bright background of the synovitis

4:04

we can see some anatomic structures very well.

4:07

For example, here, we can see the dorsal ligaments here,

4:13

the radio carpal dorsal ligament

4:16

the intercarpal dorsal ligament.

4:18

And here, we can also see the extensor retinaculum

4:24

around here,

4:26

around the tendon of the ulnar extensor tendon.

4:31

We can see also the extensor retinaculum right here.

4:34

So don't give up, even in cases

4:37

when you can see a lot of things going wrong,

4:42

a lot of disease,

4:44

you can use the case to learn a little bit more

4:49

about the anatomy,

4:50

a little bit more about something that you can just see

4:54

because there is all this disease around these structures.

4:58

Okay?

5:02

<v ->Just one, one quick comment,

5:04

and just so that people are aware,

5:07

I will talk about rheumatoid

5:09

and I'll talk a bit about

5:10

the distribution of disease

5:12

and the rheumatoid risk,

5:13

and recognizing as we've heard,

5:17

the distal ulnar early involvement

5:19

but soon pan compartment disease of the risk.

5:23

So we'll return to this topic again, later in the course.

5:27

<v ->Okay, great.