PMC5303600_01
Case of a 31-year-old male. (a, b) X-ray of the right wrist: anterior-posterior (a) and lateral (b) view. (c, d) T2-weighted magnetic resonance imaging in the sagittal (c) and coronal (d) plane, suspected diagnosis Palmer 1B lesion. (e, f) Hand arthroscopy of the same patient, showing a Palmer 2C lesion (e) and injected synovial villi at the radioscapholunate ligament (f). Figure 5(g) shows all anatomical planes in 1.5 T magnetic resonance imaging (top row, bottom left) and a three-dimensional reconstruction of the ulnocarpal disc region (bottom right) of the same patient. The defect cannot be visualized clearly in the standard planes from the MRI. The arrow points at the lesion in the ulnocarpal disc in the segmentation-based reconstruction, indicated by the flattened groove surrounded by two bulky tissue remainders on either side.
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The X-rays taken at the day of trauma and subsequently Figure 5(a) and Figure 5(b) did not show any evidence for osseous lesions. Having persistent pain and related restrictions of hand use for more than twelve weeks under continuous physiotherapy, an MRI was taken, showing an ulnar avulsion of the TFCC without any malpositioning, classified as a Palmer 1B lesion (Figure 5(c) and Figure 5(d)). The patient demonstrated a perforation of the ulnar disc (Palmer 2C, Figure 5(e)), which free ends, together with villi (Figure 5(f)), were removed by shaving debridement. TFCC revealed a central perforation at the TFCC, as indicated in Figure 5(g). This perforation was however not seen in the standard planes from MRI.