Hello ,
Having been a ped MSK for a while ,I happened to performed a satisfactory number of wrist MRI over the last 8 years in children.
I counted on my PACS 241 wrist MRI in children (< 16 year old -mainly older than 10).Overall, searching by keyword on on our PACS I have found results =0 for ECU+fissures ( 141 reports included the « word« trauma). I have 17 abnormal TFFC records. 7 DRJU with instability/ abormal.
I realise I might have overlooked some of these ECU fissures times but according by this rapid check, they might be not common in children at least in Begium ( does it depends on the local sport preferences ? mainly soccer in my area).
For the DRJU I would have completed with a series in supination as we all have learnt by our textbooks.. but doesn’t it really influence clinical decision in young patients..no idea …
Your experience ?
Other comments: These searching PACS tools are very satisfactory. You might have been using those for a while; for me this “novelty” is quite useful to give a provisional answers to specific questions not addressed by the literature , which is not rare in children).
Have a good weekend,
Paolo
Le 5 mai 2023 à 16:35, hilary umans <hilary.umans> a écrit :
I was fortunate to consult with Luis Cerezal who has published widely on this topic.He pointed out that the radial sigmoid cavity is underdeveloped and said that the most difficult problem is the incongruence of the DRUJ.
He said he would report this as a "Non-Palmer TFCC injury involving the dorsocubital capsule and ulnar insertion of the dorsal radioulnar ligament, the rest of the TFCC is intact"
Regarding the ECU, he wrote:
The hyperintense linear intrasubstance signal in the ECU could be an anatomical variant at this age (fibroadipose tissue interposed between two tendon portions is frequently seen), but upon seeing the images, I think you’re right and it’s a split of the ECU.Thank you!
On Fri, May 5, 2023 at 9:45 AM hilary umans <hilary.umans> wrote:
I’d appreciate help with this wrist MRI.This is a 13F who fell 6 months ago and reports 5/10 ulnar wrist pain at rest and 8/10 pain with prolonged use.
She is tender to palpation of the ulnar fovea and has mild pain with TFCC grind.
Though I don’t have them, outside XRs reportedly only showed positive ulnar variance.
The degree of positive variance makes me wonder if there was a missed Galeazzi fracture / dislocation, but I confirmed there were no forearm XRs done.
In addition to the positive ulnar variance, the wrist is positioned in exaggerated pronation…I’m finding it difficult to evaluate the TFCC, which is the indication for the exam.
Also, I know that normal ECU anatomy can mimic split tears….I found a surgical reference in 17 cadaveric wrists showed at least 1 split in 11 cases, but this is a child. In the axials the most proximal and distal image shows no split…so I think it’s actually a split?
With regards to the TFCC, I think the dorsal radioulnar ligament is torn.
It seems that the ulnar limb and radial insertion are intact, but I am not sure if there is a tear or stretching of the articular disc…what do you think?
Would you report a partial split of the ECU?
<13F fell 6mos ago.jpg><13F fell 6mos ago (2).jpg>
<13F fell 6mos ago (3).jpg>
<13F fell 6mos ago (1).jpg>
Thank you.
Hilary
