(OCAD) Pls help with wrist finding / pisiform sublux / hx of trauma (CT, MR)

Hi there

I’m kinda stumped by this case.

M38 fell on his hand 2 months ago, didn’t go to the doctor, imaged now b/c
the pain won’t go away.
He has ulnar sided wrist pain and sometimes dorsal metacarpal pain.

CT shows what I think is a proximally subluxed pisiform and no fractures.

The MRI shows what I think is a partial dorsal SL ligament tear (arrow) but
not much in the way of other lesions.
Granted, the proximal pisiform displacement is less convincing on the MR
scans.
There is no pisotriquetral arthritis which is sometimes associated with
pisiform subluxation.

What is your impression? Am I on the wrong track here? Is the pisiform
displacement on the CT scans only due to patient positioning?
What is the real problem here?

PPT attached….

Cheers,

Andrei