Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided X-ray and MRI images, there is a special fusion of the carpal bones located near the third carpometacarpal joint (primarily involving the capitate and trapezoid). Specific findings include:

• Local narrowing of the joint space, with irregular sclerotic changes along the edges.
• A small amount of cartilage or fibrous tissue remnants are visible locally, suggesting the possibility of incomplete osseous fusion.
• In some MRI cases, bone marrow edema signals around the joint can be detected, accompanied by subchondral cystic changes or cystic transformations (such as subchondral cystic changes).
• The overall structure is consistent with the characteristics of a “fibrocartilaginous/incomplete fusion of the capitate and trapezoid.”

II. Potential Diagnoses

Considering the patient's age, symptoms (several months of pain around the third carpometacarpal joint), and imaging findings, potential diagnoses include:

1. Capitate-Trapezoid Non-Osseous Coalition (CTC Type 1): This type of coalition often manifests as fibrocartilaginous connection or incomplete fusion, commonly accompanied by pseudarthrosis-like changes, which may lead to articular surface damage and pain.
2. Degenerative or Post-Traumatic Osteoarthritis: Joint space narrowing, irregular sclerosis, and subchondral changes are typical of degenerative changes or chronic post-injury arthritis.
3. Local Congenital Deformity or Variation Resulting in Carpal Joint Lesions: Although other types of congenital carpal coalitions are relatively rare, they may become symptomatic in adulthood.

These possibilities are mainly considered due to:

• The first condition (CTC Type 1) best explains the fibrocartilaginous partial fusion and pseudarthrosis findings, and it can easily lead to local pain after external force or repetitive motion.
• The second condition (degenerative or post-traumatic osteoarthritis) can also present with narrowing of the joint space and sclerosis, but it typically shows more extensive bony edge proliferation or findings in other areas.
• The third condition considers that congenital malformations in this region are relatively rare, but still possible.

III. Final Diagnosis

Combining the patient's symptoms, medical history, and the above imaging features, the most likely diagnosis is:

“Fibrocartilaginous Incomplete Fusion of the Capitate and Trapezoid (Carpal Coalition, Capitate-Trapezoid, Type 1).”

This type of coalition is often referred to as CTC Type 1. Because there is still a portion of fibrocartilaginous connection, it can lead to localized stress concentration and chronic pain or pseudarthrosis-related symptoms.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy

• Conservative treatment: For patients with mild symptoms and minimal functional impairment, first-line therapy includes oral nonsteroidal anti-inflammatory drugs (NSAIDs) or topical anti-inflammatory and analgesic medications, combined with immobilization or local bracing to reduce joint stress.
• Local injection therapy: If pain is significant, local injections (e.g., corticosteroids) under strict aseptic conditions may be considered, but must be evaluated by a physician.
• Surgical treatment: For persistent symptoms severely affecting function or those not responding well to conservative therapy, surgical intervention (e.g., debridement of pseudarthrosis, reconstruction, or joint fusion) may be considered. The specific approach should be determined by the patient’s condition and the state of the bones and joints.

2. Rehabilitation and Exercise Prescription

Based on the principles of gradual progression, individualization, and safety, the following exercise prescription is suggested:

1. Resting phase: During acute exacerbations or increased pain, prioritize rest and protection with a wrist brace; reduce high-intensity or repetitive wrist activities.
2. Remission phase:
   • Begin mild grip exercises and gentle wrist range-of-motion training, such as squeezing a small ball or using a soft handgrip for 3–5 minutes each time, 2–3 times per day.
   • Engage in low-intensity wrist flexion-extension and forearm pronation-supination exercises for 10–15 minutes each session, 3–4 times per week.
3. Strengthening phase:
   • Gradually increase resistance for grip training using moderate-resistance therapy bands for wrist extension, wrist flexion, and forearm rotation.
   • If no significant discomfort is present, consider using light dumbbells (1–2 pounds) for forearm muscle group exercises, performing 10–15 repetitions per set, 2–3 sets, 3 times per week.
4. Maintenance phase:
   • When pain has substantially subsided, integrate functional wrist training into daily activities and exercise routines, such as modified push-ups (undertaken cautiously) and wrist rotation against resistance.
5. Other considerations: If the patient has osteoporosis or compromised cardiopulmonary function, the exercise intensity and frequency should be adjusted based on specialist guidance.

Brief Outline of the FITT-VP Principle: Throughout the rehabilitation process, it is recommended to gradually increase the Frequency, Intensity, Time, Type, Progression, and Volume of exercise, while closely monitoring changes in pain and wrist function. Adjust accordingly in a timely manner.

Disclaimer: This report is for reference analysis only and cannot replace an in-person consultation or professional medical advice. If symptoms persist or worsen, please seek prompt medical attention and follow the recommendations of clinical experts for further examination or treatment.