3b (Hand) - Answer: 63-year-old female presents with pain in left hand

HISTORY: 

This 63-year-old female presents with pain in her left hand after a fall two weeks prior.


(QUIZ ANSWER) PRIMARY FINDING:

High-grade interstitial tear of the accessory radial collateral ligament at the second metacarpophalangeal (MCP) joint.


Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


FINDINGS:

Osseous edema involves the 2nd metacarpal head related to contusion and microfracturing. Subtle linear regions of fracture are noted on T1-weighted data sets. However, conspicuity of these fractures are such that they likely would not be visible on x-ray.

High-grade injury involves the proximal accessory radial collateral ligament of the 2nd MCP joint. The main collateral ligament is preserved although may be minimally sprained. Ulnar collateral ligament is intact as are the sagittal bands. Flexor and extensor tendons are intact.

Subtle muscle strain surrounds the distal 2nd metacarpal head and shaft. 

 

CONCLUSION

1. Intermediate-grade to high-grade interstitial tear involves the accessory radial collateral ligament of the 2nd MCP joint. The main collateral ligament is preserved. Diffuse capsular swelling and reactive capsulitis is contributory. 

2. Regions of osseous contusion and microfracturing are present throughout the distal 2nd metacarpal head.