Medical Imaging Analysis Report

1. Radiological Findings

This case involves a 17-year-old male patient who presents with right wrist pain. Based on the provided X-ray, bone scan, and CT images, the following findings are noted:

• There is a distinct space-occupying lesion in the right wrist area (primarily involving the carpal bones), with local bone expansion. The boundaries appear clear but irregular.
• The X-ray shows heterogeneous density within the lesion, including relatively radiolucent areas as well as areas of calcification or sclerosis.
• The CT scans provide a clearer view of local discontinuities in the trabecular structure, thinning of the cortical bone, local expansion, and possibly a small area of soft tissue protrusion.
• The bone scan indicates high radioactive uptake in the right wrist, suggesting active local bone metabolism.

These findings suggest a relatively slow-growing lesion with local activity that can cause significant structural changes in the carpal bones.

2. Possible Diagnoses

Based on the imaging features and the patient’s age and symptoms, the following conditions are considered:

1. Osteoblastoma
   Pathologically characterized by active osteogenesis; the lesion is often larger than 2 cm, typically occurring in young patients, and presents with bone expansion, well-defined radiographic boundaries, and marked uptake on bone scans.
2. Osteoid Osteoma
   Similar to osteoblastoma, but usually smaller than 2 cm. Commonly presents with nocturnal pain relieved by NSAIDs, often in patients under 30 years old.
3. Aneurysmal Bone Cyst (ABC)
   Typically shows expansile osteolytic destruction with cystic compartments on imaging. Frequently observed in adolescents.
4. Other benign bone tumors or tumor-like lesions
   Includes eosinophilic granuloma, enchondroma, fibrous dysplasia, etc. Although possible, the imaging characteristics more closely match osteoblastoma, making these conditions less likely.

3. Final Diagnosis

Considering the patient’s age (17 years), chronic wrist pain, and the imaging evidence of a lesion larger than 2 cm with clear boundaries, local bone expansion, and marked uptake on bone scan, the most likely diagnosis is:

Osteoblastoma.

If pathological examination confirms abundant osteogenesis, osteoid matrix, and a vascular stroma within the tumor, the diagnosis is further validated. If any doubt remains, biopsy or surgical pathological examination may be necessary to rule out malignant conditions.

4. Treatment Plan and Rehabilitation

4.1 Treatment Strategy

• Surgical Treatment: For osteoblastoma, the primary treatment is surgical, including curettage, thorough lesion debridement, and bone grafting. If the tumor is superficial and localized, resection with bone graft reconstruction can be performed. In cases of larger lesions or those near joints, it is essential to evaluate joint function and surrounding soft tissue.
• Medication Support: For pain control, NSAIDs or analgesics may be used. If bone density is low or bones are fragile, supplementation with calcium and vitamin D can be beneficial.
• Regular Follow-up: After surgery or conservative treatment, periodic imaging follow-up (X-ray or CT) is recommended to monitor for recurrence and assess bone repair.

4.2 Rehabilitation/Exercise Prescription

Rehabilitation should follow the FITT-VP (Frequency, Intensity, Time, Type, Progression, and Personalization) principles, considering wrist joint function and recovery of adjacent tissues:

1. Early Stage (1–4 weeks post-operation)
   • Frequency: 3–4 times per week.
   • Intensity: Focus on overcoming surgical trauma and pain, with gentle movements of the wrist and fingers, such as making a fist or flexing/extending the wrist.
   • Time: About 10–15 minutes per session, with short durations and multiple repetitions.
   • Type: Active and passive joint range of motion exercises, isometric muscle training (e.g., gripping a small ball, gentle manual traction of the wrist).
   • Progression: Increase gradually, depending on pain and swelling.
2. Middle Stage (4–8 weeks post-operation)
   • Frequency: 3–5 times per week.
   • Intensity: Gradually increase to light or moderate resistance exercises.
   • Time: Extend to about 20–30 minutes per session and increase the frequency of movements fitting functional training goals.
   • Type: Strengthening exercises for the muscles around the wrist (e.g., using resistance bands for flexion, extension, pronation, and supination), combined with fine motor skill training for the fingers.
   • Progression: Increase loading as the wrist stabilizes and exercise tolerance improves.
3. Late Stage (8 weeks post-operation and beyond)
   • Frequency: 3–5 times per week or adjusted based on individual recovery.
   • Intensity: Transition to moderate and moderately high intensities, guided by a rehabilitation therapist or orthopedic specialist.
   • Time: At least 30 minutes per session, integrated with daily functional tasks.
   • Type: Progress to more advanced functional exercises, including weight-bearing activities on the wrist and gradually resuming previous sports (e.g., basketball or badminton requiring wrist flexibility).
   • Progression: Balance joint range of motion and strength, avoiding overuse that could lead to secondary injury.

Bone healing and wrist function should be closely monitored. If new pain arises or if there is a sudden restriction in movement, seek medical attention promptly to rule out recurrence or other complications.

Disclaimer

This report is based on currently available information and is for reference only. It does not replace in-person clinical diagnosis, pathological examination, or professional medical advice. If you have any doubts or experience worsening symptoms, please seek professional medical help at a qualified hospital promptly.