FINDINGS: Alignment: Scapholunate dissociation and VISI deformity. Mild radial shortening
Distal radioulnar joint: Congruent
Fluid:
Carpus effusion: Small effusion. Synovial thickening: Mild. Intra-articular body: Body/blood clots in the ulnar styloid recess.
Distal radioulnar joint effusion: Small effusion.
Intrinsic ligaments:
Scapholunate: Partial tear of the dorsal band. Volar band is not well visualized and is torn along the membranous portion with scapholunate dissociation.
Lunotriquetral: Volar band is partially intact. The membranous and dorsal portions are torn.
Ulnar side:
Triangular fibrocartilage ligament: Central disc perforation. Additional partial tear of the styloid attachment
Lunate facet: Type I facet.
Hamate-lunate: Subchondral cysts of the proximal hamate.
Ulnocarpal impaction: Present. Subchondral cysts and edema of the lunate and triquetrum with osteochondral fracture deformity of the ulnar aspect of the lunate.
Extensor compartment:
I: Mild tendinopathy with mild tenosynovitis.
II: Mild tenosynovitis.
III: Mild tenosynovitis and abuts the radial fracture involving the lateral aspect of the Lister’s tubercle.
IV: Mild tenosynovitis.
V: Normal.
VI: Mild to moderate tendinopathy.
Flexor compartment:
Flexor retinaculum: Intact.
Common flexor tendons: Mild flexor tenosynovitis.
Flexor pollicis longus tendon: Normal
Flexor carpi radialis longus tendon: Normal
Carpal tunnel: Effaced fat in the carpal tunnel.
Median nerve: Abnormally hyperintense, flattened in the tunnel with proximal enlargement. Prominent fascicles in the carpal tunnel
Guyon canal: Normal.
Articular:
Thumb carpometacarpal / Metacarpophalangeal joints: Mild degenerative changes with small effusion.
Lesser carpometacarpal joints: Normal.
Scaphotrapeziotrapezoidal joint: Normal.
Pisiform-triquetral joint: Tiny synovial cyst.
Extrinsic ligaments:
Radial collateral ligament: Mild thickening.
Ulnar collateral ligament: Mild thickening.
Dorsal intercarpal ligament: Adjacent synovitis. Tiny ganglion adjacent to the radial lunotriquetral ligament
Volar extrinsic ligament: Intact.
Bones: Oblique fracture of the lateral aspect of the distal radius extending to the lateral aspect of the scaphoid fossa in the radiocarpal joint. Minimal radial displacement. Scattered carpal cysts with mild deformity of the proximal pole of the scaphoid from prior injury.
Muscles: Denervation edema and mild of the thenar muscles with sparing of the adductor pollicis
Vessels: Normal.
Other: None.
IMPRESSION:
Minimally displaced distal radial fracture with mild radial shortening. Scapholunate dissociation and VISI deformity with tears of the scapholunate and lunotriquetral ligaments as described. Osteochondral injury of the proximal pole of the scaphoid and ulnar aspect of the lunate. Underlying chronic ulnar carpal abutment and central TFCC disc tear.
Findings of acute carpal tunnel syndrome with denervation edema and atrophy of the thenar muscles. Clinical correlation is suggested.
NS-RADS: Nerve: E2 – Moderate entrapment, Muscle: M2 – Muscle edema-like signal and minimal fatty replacement or mild atrophy
RECOMMENDATIONS: Carpal tunnel release
Avneesh Chhabra, M.D. M.B.A.
Professor Radiology & Orthopedic Surgery
Chief, Division of Musculoskeletal Radiology
UT Southwestern Medical Center, Dallas, Tx
5373 Harry Hines Blvd.
Dallas, Tx-75390-9178
Office: 214-648-2122
avneesh.chhabra
