ORTHOPAEDICS
Case 14 :
53-year-old female, presents with pain on flexing wrist, while opening window or holding articles. A slight swelling was noted on the flexor aspect of the wrist. MRI was performed. What is the diagnosis?
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Imaging Diagnosis
Carpal Tunnel Syndrome

Discussion
CAUSES:

  • Idiopathic
  • Colle’s fracture
  • RA
  • Gout
  • Median nerve tumors or tumors compressing median nerve

MRI FEATURES:

  • Enlarged median nerve at level of pisiform
  • Flattening of nerve at level of hamate
  • Palmar bowing of flexor retinaculum at level of hamate
  • Hyperintensity of nerve - Fat sat PD or FSE or STIR most sensitive
  • Comparison with opposite side may be misleading as involvement is bilateral in ½ to 1/3rds of the pts.
    Alteration of signal may be non specific
  • Ratio of cross sectional area of nerve at pisiform to area of nerve at level of distal radius. Significant difference is doubling



MRI Centre, Nanavati Hospital, Mumbai
DR DEEPAK PATKAR, DR MALINI LAWANDE, DR SONA PUNGAVKAR,
DR SHILPA SANKHE, DR ANKIT TANDON & DR NISHA SAINANI