Age / Sex : 77 / F

Chief complaint : Left wrist pain, Trauma Hx (+) 10 months ago

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Courtesy :  김옥화(Kim Ok Hwa),  인제대해운대백병원(Inje University Haewoondae Paik Hospital)

Symptomatic incomplete fibrocartilainous lunotriquetral coalition

Discussion

Findings:

1.     Plain radiograph of left wrist shows Irregular and narrowing of proximal lunotriquetral joint space with periarticular bony sclerosis.

2.     Coronal T1W and FS T2W MRI of left wrist show adjacent bone marrow edema in lunotriquetral joint and a periartcular cystic lesion in triquetrum. FS T2WI shows hyaline cartilage in distal lunotriquetral joint

Differential Diagnosis:

1. Lunocarpal impaction syndrome
   
2. TFCC lesion

Diagnosis:  

incomplete fibrocartilaginous lunotriquetral coalition (type I)

Discussion:

The most common isolated carpal coalition is the lunotriquetral, followed by the capitohamate. Lunotriquetral coalition may show incomplete fusion (type I), proximal osseous bridge with a distal notch (type II), complete fusion (type III), or fusion with associated carpal abnormalities (type IV). Most isolated carpal coalitions usually remain asymptomatic and present as incidental radiographic findings; however, some partial coalitions (type I) may become symptomatic secondary to cartilaginous destruction of the synchondrosis or osteoarthritis

References:

1.     Clinically significant skeletal variations of the shoulder and the wrist: role of MR imaging J.M. Mellado J. CalmetS . Domenech A. Sauri. Eur Radiol. 2003; 13:1735–1743

2.     Symptomatic fibrous lunato-triquetral coalition A. Stäbler1, C. Glaser1, M. Reiser1, D. Resnick. Eur Radiol. 1999; 9 :1643-1646

3.     Pseudoarthrosis after disruption of an incomplete luno-triquetral fibrocartilaginous coalition. German Medical Science 2010; vol 8:ISSN 1612-3174