[image: wrist consult 32F 1.5yr post op ulnar pain.jpg]
[image: wrist consult 32F 1.5yr post op ulnar pain (1).jpg]
[image: wrist consult 32F 1.5yr post op ulnar pain (2).jpg]
[image: wrist consult 32F 1.5yr post op ulnar pain (3).jpg]
MRI of 32F 1.5 years post central TFCC tear debridement with 1 month
recurrent ulnar wrist pain, no trauma.
I think the TFCC looks fine; small chronic defect with minimal DRUJ fluid.
My questions are:
1. Is the ECU subluxed? There is a flat dorsal ulnar groove; there is no
supination or pronation of the wrist, but the ECU seems perched on the
medial margin of the ulnar styloid. I think the subsheath looks intact and
there is no tenosynovitis or tendinosis.
2. Sag images demonstrate dorsal subluxation of the capitate and hamate at
the mid carpus, which seems odd. I don’t have XRs. Can this be artifactual
due to positioning?
Coronal images show the hand is ulnar deviated and Sag shows that the hand
is dorsiflexed. I realize that our protocol handbook does not specify
proper hand positioning. I know that I used to insist on neutral
positioning with long axis distal radius aligning with long axis 3rd
metacarpal…and I suspect that ulnar deviation might limit evaluation of
the TFCC and radioulnar ligaments. Do you have a standard protocol for
positioning? It is a little challenging as we have many different MRI with
different surface coil types.
wrist-consult-32F-1.5yr-post-op-ulnar-pain.pdf
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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