A 76 years old genteman presented with pain in the left wrist and fever. After laboratory tests and radiological investigations, it was diagnosed as a case of multiple cysts in the carpal bones.
A 76 years old gentleman came to the Emergency Department with a history of pain in the left wrist that was of sudden onset, mild to moderate in intensity, aggravated by movement and relieved by rest. He had also mild fever for some days. On examination, there was tenderness in the carpal bones. No neurological dificit was detected. Movement of wrist was slightly restricted. But that of the fingers was within normal range. Clinically, it was diagnosed as a case of Septic arthritis of the left wrist. However, the radiological investigations were suspicious. Initially, plain xray of left wrist was taken that revealed a cystic lesion in the trapezoid (Fig1). Then MRI scan of the wrist was done. That confirmed multiple cysts in the trapezoid and lunate bones (Fig2).
Cystic lesions in the carpal bones are not very rare 1. But their presentation, origin and mechanism may vary from patient to patient. There were some cases reported as cysts in the carpal bones 1,2,3,4. Some of them were reported to have history of injury/ trauma 1, some were neoplastic 4, one was aneurysmal cyst 2, one was ganglion cyst 3 while others were of unknown origin. In our case, there was no history of trauma and the presentation was that of septic arthritis of the wrist. The MRI and x-ray were sufficient investigative tools for diagnosis. The patient was treated with surgical curettage. His post-operative outcome was quite satisfactory.
Multiple cysts in carpal bones.
This patient is a 76-year-old male, presenting with left wrist pain and accompanying fever. Based on the provided X-ray and MRI images, the following observations can be made:
Overall, these findings suggest multiple cystic lesions within the left wrist joint, combined with the patient’s fever, local pain, and laboratory results indicating a possible infection.
Based on the radiological presentation and patient history, the following diagnoses or differential diagnoses may be considered:
Taking into account the patient’s age, symptoms (pain and fever), medical history (no significant trauma), lab findings (elevated infection markers), the multiple cystic changes in the carpal bones as seen on imaging, and operative findings, the most likely diagnosis is:
“Multiple cystic lesions in the left wrist bones with concurrent infection (suspected suppurative/infectious arthritis).”
Surgically, curettage of the lesions has been performed. Histopathologic analysis and bacterial culture can help confirm the pathological nature and the infectious agent. If the pathological and culture results correlate, the diagnosis can be definitively established and guide further treatment.
Rehabilitation Principle: Follow a gradual and individualized approach, considering the patient’s age and bone condition.
Throughout the rehabilitation process, carefully monitor wrist pain, swelling, and changes in range of motion. If significant discomfort or signs of recurrent infection occur, seek medical evaluation promptly. In cases of osteoporosis or reduced cardiopulmonary function, consult specialists or rehabilitation therapists to formulate a more cautious rehabilitation plan.
This report is for reference only and cannot replace an in-person consultation or professional medical advice. Specific treatment and exercise plans should be carried out under the guidance of qualified medical or rehabilitation professionals.
Multiple cysts in carpal bones.
