Foreign body - wrist

Case contributed by Dr Maulik S Patel

Presentation

Metal related worker. H/o penetrating injury to wrist by a metal particle - 2 months back. C/o local pain - 1 month.

Patient Data

Age: about 40 yrs
Gender: Male

Recent radiograph ( 5 days back ) - metal opasity overlying distal dorsal radius.

Modality: Ultrasound

There is an echogenic focus ( about 3 mm ) with reverberation artifact extensor carpi radialis brevis tendon. Color dopplar shows twinkle artifact. 

It is about 12 - 14 mm distal to radio-carpal joint. It is distal to scaphoid and overlies distal raw carpal bone. It abutts deeper surface of tendon.

There is no tenosynovitis. There is no local granuloma.

Modality: Photo

Intra-operative photograph showing metal foreign body.

Case Discussion

Findings suggest foreign body in wrist. There are two artifacts which help to locate foreign body. On gray scale, there is reverberation artifact. On color dopplar scan, there is twinkle artifact.

Two possibilities should be keep in mind while looking for a foreign body.

Migration of foreign body - as in this case. Metal focus migrated from dorsal distal aspect of radius ( shown in previous radiograph - no copyright, not uploaded ) to distal carpal bone level.

Fragmentation can occur if foreign body is a wood splinter or thorn. In case of radiolucent ( like wood splinter ) foreign bodies, sonographer is only aware of approximate size of foreign body suggested by patient. And in such cases, fragmentation can occur revealing more than one foreign body.

Intra-operative photograph - courtesy operating surgeon Dr Ritesh Patel

 

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Case Information

rID: 44267
Case created: 14th Apr 2016
Last edited: 6th Nov 2016
Inclusion in quiz mode: Included

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