Upcoming Events
Log In
Pricing
Free Trial

Wk 5, Case 4 - Review

HIDE
PrevNext

0:00

All right.

0:01

We have images on a 61 year woman who has pain and swelling

0:06

of her wrist.

0:08

The main findings here concern to the diffuse loss of articular

0:13

cartilage throughout the intercarpal radiocarpal

0:18

and carpal metacarpal joints.

0:20

So you can follow the subc plates of these individual carpal bones.

0:25

And you see how there is diffused loss of articular cartilage

0:30

associated with the presence of subc reactive mar edema,

0:34

which is also quite diffused,

0:37

and the presence of inflammatory panels formation.

0:41

So we have this tension of the capsule of the wrist of the

0:46

distal radio ulnar joint, radiocarpal joint mid carpal joint,

0:50

and on axial fluid sensitive T two weight sequence

0:55

with a fat suppression.

0:57

We see the presence of these front like projections coming from the

1:02

capsule compatible with synovial proliferation in the

1:07

setting of rheumatoid inflammatory panels.

1:10

It's very important when we have suspicion for rheumatoid arthritis to assess

1:15

the triangular fibrocartilage, which is frequently involved,

1:19

as well as the skin for lunate ligament.

1:21

This patient had a complete tear of the triangular fibrocartilage disc,

1:26

is allowing for communication of the distal radio onar joint with the

1:32

radiocarpal joint,

1:33

and there is also associated stem cell carpi OC

1:38

synovitis.

1:39

The tendon sheet is also the standard outlining tecan

1:43

inflammatory synovial falls,

1:46

as well as here of the stem carpi standard.

1:51

So in summary,

1:52

diffuse pan carpal arthritis with associated

1:57

inflammatory panels formation,

2:00

tear of the triangular fibro cartilage and associated car

2:05

steno and tear.

2:08

One important additional finding here is the presence of that erosive change

2:13

in the, so thats the diagnosis of rheumatoid arthritis in.

Report

Patient History
61-year-old female with left wrist pain and swelling.

Findings

ALIGNMENT:

Ulnar Variance: Neutral.

Distal Radioulnar Joint: Dorsal subluxation of the distal ulna.

Carpal Instability: Multifocal intraosseous synovial pits or “ganglions” in keeping with biomechanical friction sequelae.

ARTICULATIONS:

Severe arthrosis of the wrist articular surfaces with diffuse penetrating erosions, reactive osteoedema of the carpal bones and the proximal 3rd and 4th metacarpal bases with widening of the distal radioulnar joint. Dorsal subluxation of the distal ulna. Radial subluxation of the 1st metacarpal base at the 1st carpometacarpal joint.

Carpal Effusion: Diffuse fluid distension and reactive synovitis throughout the radiocarpal and intercarpal joints associated with capsular laxity, capsulosynovitis and pannus formation, which is more conspicuous in the dorsal wrist.

Distal Radioulnar Joint Effusion: Fluid distension of the distal radioulnar joint.

INTRINSIC LIGAMENTS:

Scapholunate Ligament: Diffuse swelling and laxity of the scapholunate ligament without complete rupture.

Lunotriquetral Ligament: Intact.

Triangular Fibrocartilage: Chronic maceration of the triangular fibrocartilage complex (TFCC) disc proper and its attachments.

Extensor Compartment: Tenosynovitis of the extensor compartment tendons sparing the 1st extensor compartment (abductor pollicis longus and extensor pollicis brevis). Hypertrophic delamination with split tear of the extensor carpi ulnaris measuring about 5-6 cm.

Flexor Compartment: Intact.

Carpal Tunnel: Normal.

Median Nerve: Normal.

Flexor Retinaculum: No thickening or palmar bowing.

Flexor Tendons: No tendinosis, tenosynovitis or tendon rupture.

Guyon's Canal: Normal.

Impressions
1.Severe left wrist osteoarthrosis associated with diffuse joint effusion and extensive capsulosynovitis, synovial hypertrophy and pannus formation, constellation of findings highly suspicious for a systemic inflammatory condition, favoring rheumatoid arthritis.
2.Dorsal subluxation of the distal ulna at the radioulnar joint with widening of the radioulnar joint space secondary to radioulnar ligament and capsular laxity.
3.Diffuse extensor compartment tenosynovitis sparing the 1st extensor compartment and 5-6 cm hypertrophic delamination of the extensor carpi ulnaris tendon.
4.Chronic maceration of the TFCC disc proper and its attachments.

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