Ulnar wrist pain, MRI. 32F 1.5 yrs post op TFCC debridement with recurrent ulnar pain.

There were some conflicting opinions….some thought it was definitely
artifact of positioning, while others thought that it is definitely
abnormal.
Some were certain this is DISI and others wondered if it might be….but
would not call it if the SLL looked intact.
The majority (not all) thought the ECU subsheath looked chronically torn,
with an intact extensor retinaculum.
Here are some additional images.
It is possible to measure a corrected scapholunate angle on the Sagittals
by scrolling between images to find the landmarks and comparing to a
standard baseline…in this case, the corrected SL angle is normal.
Ax and Cor images show an intact scapholunate ligament.
This is Not DISI.
With the wrist ulnar deviated and the ulna a bit short, and noise in some
axial slices, I find it a bit challenging to conclude the ECU subsheath is
chronically torn, but I don’t really see it—so probably true. Though
without tendinosis or tenosynovitis, I’m not sure if it’s symptomatic.
So I remain completely confused about the apparent malalignment at the
midcarpal joint…pathologic vs positional? I don’t know.
I definitely don’t like ulnar deviated positioning for evaluation of ulnar
wrist pathology….Does anyone prescribe standard positioning for wrist MRI?
[image: Slide1.jpeg]
[image: Slide2.jpeg]
[image: ax PDFS ECU.JPG]

On Fri, Jan 29, 2021 at 12:50 PM hilary umans <hilary.umans@gmail.com>
wrote:

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