Pain and swelling. Cyst on dorsum of wrist with lunate cyst. A combination of fluid and intermediate signal intensity surrounds the tendons of the fourth extensor compartment as they course dorsal to the distal radius, indicating tenosynovitis. Multiple separate tendon slips are noted, which may either reflect anatomic variation or chronic longitudinal tearing. At the level of the radiocarpal joint, the fluid surrounding the tendons disappears, but there is thickening of the supratendinous extensor retinaculum. Distal to the retinaculum, fluid is noted within the fourth extensor compartment extending to the level of the metatarsal bases, indicating additional tenosynovitis. One of the slips of the extensor indicis tendon is markedly enlarged with foci of high signal intensity that likely reflects a combination of severe tendinosis and partial-thickness tearing. A relatively small amount of fluid is noted adjacent to the tendons of the first, second, and third extensor compartments, perhaps representing relatively mild tenosynovitis, but not necessarily of any current clinical significance. There is enlargement of the extensor carpi ulnaris tendon as it courses along the ulnar styloid with linear intrasubstance signal that extends to the surface of the tendon suggesting a partial thickness tear; there is only trace fluid within the extensor carpi ulnaris tendon sheath, however. The flexor tendons are unremarkable.There is a lobulated and branching mass of fluid signal intensity along the volar lip of the distal radius measuring just over 1 cm in mediolateral dimension, approximately 1 cm in craniocaudal dimension, and approximately 6 mm in AP dimension, likely representing a ganglion, perhaps arising from the attachment of the long radiolunate ligament. There is also a small lobulated collection of near-fluid signal intensity along the ulnar neurovascular bundle at the level of the proximal diaphysis of the fourth metatarsal which may represent a small ganglion or varix.There is a slight negative ulnar variance. There is mild increased signal intensity within the medial fibers of the articular disc of the triangular fibrocartilage complex suggestive of degenerative tearing at its ulnar styloid attachment. There is heterogeneous abnormal signal intensity within the lunate bone concentrated along its periphery, particularly medially, which is of low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. This may represent a cluster of degenerative cysts or intraosseous ganglia, although the possibility of an unusual pattern of osteonecrosis is also considered. Centrally, the marrow signal of the lunate is relatively preserved. A couple of small foci of signal abnormality within the scaphoid and capitate are of doubtful clinical significance. Moderate osteoarthritis affects the basilar joint, with thickening of its capsular ligaments.Evaluation of the intrinsic ligaments of the wrist is limited due to lack of intra-articular contrast, but I see no specific findings of disruption.
Fourth extensor compartment tenosynovitis and other findings as described above.