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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.
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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Prepare trainees to be on call for the emergency department with this specialized training series.
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
A 62 year old woman who presented with pain in the wrist and
0:06
demonstrated increased density of the lunate on prior
0:11
radiographs.
0:12
The suspicion was disease on corona fluid sensitive
0:17
sequence. This is a fat suppressed protein density image.
0:21
We see complete diffuse replacement of the
0:26
marrow signal in the lunar bone by heterogeneous
0:31
mix, bright and low signal intensity areas.
0:35
In keeping with avascular necrosis on T one weighted images,
0:40
we see predominant low signal intensity,
0:43
which correlates with the radiographic finding of diffuse
0:48
sclerosis in the setting of kBox disease.
0:52
Sagittal gradient echo image allow us to see a slight
0:57
tilt, dorsal tilt of the ate,
0:59
as well as the diffuse bone marrow signal abnormality.
1:04
The differential diagnosis here is primarily with an osteochondral
1:09
injury to the lunate bone,
1:11
and typically those are characterized but only
1:15
focal marrow signal abnormality.
1:18
This diffuse replacement of the marrow is pathognomonic
1:23
of Kim Box's disease and that is the diagnosis in this patient,
1:28
which should also search for the presence of SubCal plate collapse,
1:32
which may happen either on the proximal or distal articulating
1:37
surfaces of the lunar. In this patient, there is very,
1:40
very subtle indentation of the subcon plate proximally,
1:46
which indicates that this patient is already on the way to develop
1:51
collapse of the ate bone in more advanced stage of
1:56
chemical.
Wk 5, Case 3 - Review
HIDEInteractive Transcript
0:01
A 62 year old woman who presented with pain in the wrist and
0:06
demonstrated increased density of the lunate on prior
0:11
radiographs.
0:12
The suspicion was disease on corona fluid sensitive
0:17
sequence. This is a fat suppressed protein density image.
0:21
We see complete diffuse replacement of the
0:26
marrow signal in the lunar bone by heterogeneous
0:31
mix, bright and low signal intensity areas.
0:35
In keeping with avascular necrosis on T one weighted images,
0:40
we see predominant low signal intensity,
0:43
which correlates with the radiographic finding of diffuse
0:48
sclerosis in the setting of kBox disease.
0:52
Sagittal gradient echo image allow us to see a slight
0:57
tilt, dorsal tilt of the ate,
0:59
as well as the diffuse bone marrow signal abnormality.
1:04
The differential diagnosis here is primarily with an osteochondral
1:09
injury to the lunate bone,
1:11
and typically those are characterized but only
1:15
focal marrow signal abnormality.
1:18
This diffuse replacement of the marrow is pathognomonic
1:23
of Kim Box's disease and that is the diagnosis in this patient,
1:28
which should also search for the presence of SubCal plate collapse,
1:32
which may happen either on the proximal or distal articulating
1:37
surfaces of the lunar. In this patient, there is very,
1:40
very subtle indentation of the subcon plate proximally,
1:46
which indicates that this patient is already on the way to develop
1:51
collapse of the ate bone in more advanced stage of
1:56
chemical.
Report
Patient History
62-year-old female with increased density and stippling of the lunate. Mass on right posterior wrist causing pain.
Findings
ALIGNMENT:
Ulnar Variance: Neutral.
Distal Radioulnar Joint: Normal.
Carpal Instability: No dorsal or volar intercarpal segmental instability. No scapholunate advanced collapse.
ARTICULATIONS:
Thumb Carpometacarpal Joint: Thickening of the anterior oblique ligament with mild malalignment, marginal osteophytes and subcortical intraosseous cysts in the ulnar aspect of the 1st metacarpal base.
Scaphotrapeziotrapezoidal Joint: Normal.
Pisiform-Triquetral Joint: Normal.
Radiocarpal Joint: Normal.
Distal Radioulnar Joint: Normal.
Fluid: As described above.
Carpal Effusion: None.
Distal Radioulnar Joint Effusion: Mild.
INTRINSIC LIGAMENTS:
Scapholunate Ligament: Derangement and insufficiency of the dorsal band of the scapholunate ligament with 4 mm diastasis of the corresponding joint.
Lunotriquetral Ligament: Intact.
Triangular Fibrocartilage: Chronic autodigestion or large perforation of the triangular fibrocartilage complex disc proper.
Lunate Facet: Chondromalacia of the lunate and triquetrum.
Hamate-Lunate Facet: Normal.
Extensor Compartment: No tendinosis, tenosynovitis or tears.
Flexor Compartment: No tendinosis, tenosynovitis or tears.
Carpal Tunnel: No space-occupying lesions in the carpal tunnel.
Median Nerve: Normal.
Flexor Retinaculum:
Flexor Tendons: No tendinosis, tenosynovitis or tears.
Guyon's Canal: No space-occupying lesions.
OTHER FINDINGS:
Skeleton: Confluent sclerosis and mild osteoedema involving the entire lunate. Early depression of the proximal cortical surface of the lunate without pronounced or overt collapse.
Soft Tissues: A 0.3 cm x 1.1 cm (AP x transverse) lobulated cystic structure in the dorsal aspect of the wrist overlying the Lister tubercle in keeping with a ganglion pseudocyst.
Vessels: Unremarkable.
Impressions
1.Chronic Kienbock disease without fragmentation or collapse.
2.Chronic wearing or perforation of the TFCC disc proper with mild fluid distension of the distal radioulnar joint and associated with lunate chondromalacia (Palmer class 2C).
3.A 0.3 x 1.1 cm ganglion pseudocyst in the dorsal aspect of the wrist overlying the Lister tubercle.
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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