Do you see the injury?
How about now?
It’s more difficult in the Sag plane
There is a chronically dislocated radial sesamoid with minimal marrow edema and mild volar radial pericapsular edema
I reached out to the hand surgeon who said that she has never seen this in practice, but the literature describes thumb sesamoid dislocation with hyperextension injury or dislocation
It implies a previous tear of the volar plate, but we don’t see a residual bright T2 defect, presumably from scar remodeling (not that I have a one track mind….but think about that in the context of all of those "intact" plantar plates you see, with acquired toe deformity and pericapsular soft tissue thickening that you can’t explain)
Back to this thumb….the case reports describe locking or clicking in cases where the dislocated sesamoid is incarcerated / entrapped in the joint.
Because this is not, she told me she would treat this conservatively.
Small things are hard to see….especially on MRI
Hilary
