Image Quiz
Posttraumatic Wrist Pain1
A twenty-six-year-old, left-hand-dominant woman presented with pain in the left wrist. The symptoms had developed two months prior to presentation, several days after a motor-vehicle accident in which the patient had struck the dashboard with her wrist. Radiographs of the left wrist that had been made at that time reportedly showed normal findings.
At the time of examination, the patient had moderate pain on the ulnar side of the left wrist that worsened with activity. There was tenderness along the ulnar aspect of the wrist. Provocative maneuvers for ligamentous instability were negative, but the patient had discomfort on the triangular fibrocartilage complex grind test, which is performed by placing an axial load on the wrist, positioning the wrist in ulnar deviation, and rotating the forearm. New radiographs of the wrist revealed normal findings (Figs. 1-A and 1-B). A presumptive diagnosis of a triangular fibrocartilage complex tear was made, and conservative treatment with a six-week course of wrist-splinting was recommended.
Fig. 1-A |
Fig. 1-B |
Figs. 1-A and 1-B Posteroanterior (Fig. 1-A) and lateral (Fig. 1-B) radiographs of the wrist, made two months after the injury, showing no obvious evidence of osseous injury.
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The patient returned for reassessment two months later with continued pain in the ulnar aspect of the wrist. A computed tomographic examination was performed (Figs. 2-A and 2-B).
Fig. 2-A |
Fig. 2-B |
For larger view, click on image |
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