1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Thomas C Alewine Affiliation: National Capital Consortium

2. MedPix No: 6867 - History Pt Demographics: Age = 16 y.o. Gender = boy Several weeks history of left wrist pain. No reported trauma. Otherwise in good health, on no medications. Downloaded by (-1)

3. MedPix No: 6867 - EXAM & LABS No specific areas of tenderness. No abnormalities reported on range of motion. Questionable palpable nodule/ganglion radial aspect of wrist. No labs drawn.

4. Congenital Carpal Fusion Partial fusion of capitate-hamate and fusion of lunate-triquetrum. Normal bony mineralization, no soft tissue abnormalities, no fracture. - Downloaded by (-1)

5. Congenital Carpal Fusion Partial fusion of capitate-hamate and fusion of lunate-triquetrum. Normal bony mineralization, no soft tissue abnormalities, no fracture. - Downloaded by (-1)

6. Congenital Carpal Fusion Partial fusion of capitate-hamate and fusion of lunate-triquetrum. Normal bony mineralization, no soft tissue abnormalities, no fracture. - Downloaded by (-1)

7. Congenital Carpal Fusion Partial fusion of capitate-hamate and fusion of lunate-triquetrum. Normal bony mineralization, no soft tissue abnormalities, no fracture. - Downloaded by (-1)

8. Congenital Carpal Fusion Partial fusion of capitate-hamate and fusion of lunate-triquetrum. Normal bony mineralization, no soft tissue abnormalities, no fracture. - Downloaded by (-1)

9. Congenital Carpal Fusion Partial fusion of capitate-hamate and fusion of lunate-triquetrum. Normal bony mineralization, no soft tissue abnormalities, no fracture. - Downloaded by (-1)

10. Congenital Carpal Fusion Partial fusion of capitate-hamate. Normal bony mineralization, no soft tissue abnormalities, no fracture. - Downloaded by (-1)

11. FINDINGS Left hand plain radiograph: partial fusion capitate-hamate, fusion lunate-triquetrum. Normal bony mineralization. Joint spaces preserved. No fracture or soft tissue abnormalitiesMR: Confirmed plain film findings. No nodule or ganglion or soft tissue abnormality was identified

12. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Carpal Fusion

13. Diagnosis: Congenital Carpal Fusion Dx Confirmed by: Characteristic radiographic appearance

14. DISCUSSION Symptoms and signs are usually entirely lacking with pain being the more common complaint of those symptomatic. Symptomatic patients usually have partial coalitions and cystic changes in the adjacent bones. Risk of fracture exists in the presence of a fused carpus. Fusion between bones of the proximal and distal carpal rows or between the carpal bones and radius or ulna generally is associated with additional malformations to include: tarsal coalition or one of a variety of congenital syndromes, such as acrocephalosyndactyly syndrome, arthrogryposis, diastrophic dwarfism, Ellisvan Creveld syndrome, hand-foot-uterus syndrome, Holt-Oram syndrome, otopalatodigital syndrome, Turner*s syndrome, or symphalangism. - - The cause of the carpal fusion is a segmentation failure of the primitive cartilaginous canals and absence of joint formation. The osseous centers of the involved carpus coalesce at variable ages, usually between 6 and 15 years of age. - - Source: Diagnoses of Bone and Joint Disorders, 3rd Edition, W.B. Saunders Company, Resnick