Presentation
Chronic pain at the base of the thumb with limitation of movement.
Patient Data
Reduced joint space, marginal lipping, osteophytes formation, subchondral cystic changes and thinning of articular cartilage involving first carpometacarpal joint suggesting degenerative osteoarthritic changes associated with mild-to-moderate joint effusion with synovial thickening suggesting chronic degenerative synovitis.
Patchy heterogeneous oedematous marrow signals with cystic changes are seen involving base of first meta-carpal bone eliciting low T1, higher T2 and mixed high STIR signals. Associated cortical irregularity and denudation of the overlying articular cartilage.
Additionally seen, thinning and distal retraction of the anterior oblique ligament (AOL) and coronal STIR image shows the development of volar synovial recess
Subsequently, dorsoradial subluxation of the base of the first metacarpal respect to trapezoid bone with thickening of dorsal ligament complex
Small subchondral degenerative pseudo cystic changes along proximal scaphoid and triquetrum bones (low T1, high T2 and STIR signals)
Case Discussion
Findings are suggestive of advanced degenerative osteoarthritic changes of the first carpometacarpal (trapeziometacarpal) articulation with joint effusion, periosteal stripping from the base of first metacarpal and development of volar synovial recess and eventually proximal migration and injury of anterior oblique ligament as well as dorsal subluxation /dislocation of the first metacarpal bone.
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