Presentation
Fell with pain 2 weeks prior. Initial x-rays negative for fracture.
Patient Data
No fracture or dislocation. Soft tissue swelling over the distal ulna.
Alignment is within normal limits. No focus of bone marrow edema or fracture. No joint effusion.
3 mm volar ganglion cyst with a pedicle extending towards the volar band scapholunate ligament, which is mildly high signal but no significant tear is identified. Interosseous and dorsal bands scapholunate ligament are intact. Lunotriquetral ligament is intact. Extrinsic ligaments of the wrist are intact.
TFCC appears uninjured. Mild extensor carpi ulnaris tendon sheath thickening. Remaining extensor tendons are intact. Flexor tendons are intact.
Soft tissue edema around the ulnar nerve, which has a normal appearance. Normal median nerve.
Ulnar-sided subcutaneous hematoma measuring at the level the distal ulna and ulnocarpal joint. More extensive subcutaneous edema around ulnar-aspect of the distal forearm to dorsal hand.
Case Discussion
This case demonstrates that soft tissue hematomas can be the cause for pain and swelling with no major ligamentous injury or fracture. Follow-up x-rays are the most appropriate initial follow-up imaging, and as this patient was an elite junior athlete an MRI was subsequently performed.
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