Wrist pain, prior osteomyelitis A ball arthroplasty of the first carpometacarpal joint is noted with areas of susceptibility artifact overlying the surgical site.There is diffusely increased T2 signal with fragmentation and cystic changes throughout the carpal bones particularly involving the lunate. There is corresponding low signal throughout the carpal bones as well with areas of further decreased T1 signal involving the proximal pole of the scaphoid and the majority of the lunate. Following contrast administration, there is enhancement of the majority of the carpal bones excluding the proximal pole of the scaphoid and the majority of the lunate. There is no evidence of a focal fluid collection. There is diffuse soft tissue edema and enhancement following contrast representing inflammation.The flexor tendons appear unremarkable. The median nerve is enlarged. There is mild fluid surrounding the e fourth extensor compartment.
Abnormal marrow signal throughout the majority of the carpal bones with areas of further decreased signal involving the proximal pole of the scaphoid and portions of the lunate. Given these changes, the possibility of chronic osteomyelitis cannot be excluded. Alternatively, this may be the result of severe degenerative change with areas of avascular necrosis involving the scaphoid and lunate.