Hand septic arthritis and osteomyelitis (MRI)

Case contributed by Dai Roberts


Increasing hand pain and swelling

Patient Data

Age: 60 years
Gender: Male

Extensive edema throughout the carpal bones and 2nd to 5th metacarpal bases, and to a lesser degree the distal radius and ulna.  Associated severe dorsal carpus synovitis with edema extending into the intrinsic hand musculature.  Tenosynovitis of flexor carpi radialis and to a lesser degree some of the extensor tendons.  

Case Discussion

The degree of bony changes and synovitis is concerning for septic arthritis and osteomyelitis.  An inflammatory arthritis is within the differential. Clinical correlation is important in these cases and some will go on for aspiration, but in the wrist and hand, there is often very little fluid to sample. 

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