Osteophyte Formation and Radiocarpal Ligament Tendinopathy: A Case Report

Case Diagnosis: Sprain of the Right Radiocarpal Ligament with Associated Tendinopathy

Case Description or Program Description: A 42-year old male, a competitive bowler, presented with persistent right wrist pain following an acute injury sustained while performing a household task. He described a "pop" sensation, followed by dull, constant pain and instability. Initial urgent care imaging revealed scapholunate widening, leading to a referral for further evaluation. The patient was diagnosed with a right radiocarpal ligament sprain and was prescribed a brace and a Medrol Dosepak, which provided some relief at the clinic. However, despite the use of the brace, he experienced increasing pain during movement. He reported worsening discomfort during radial and ulnar deviation, flexion, and extension. A corticosteroid injection into the radiocarpal joint provided approximately 85-90% pain relief, although some discomfort persisted during rotation and full wrist flexion.

Setting: Outpatient Orthopedic Clinic

Assessment/Results: Upon examination, wrist range of motion was largely preserved, with mild extension limitations. Palpation revealed no significant tenderness. Ultrasound revealed flexor impingement due to osteophyte formation at the distal radius and capitate. A structured rehabilitation plan focusing on mobility, stability, and progressive strengthening was initiated. The patient was referred to physical therapy, with follow-up scheduled in 12 weeks.

Discussion (relevance): Radiocarpal ligament injuries exhibit varying severity, affecting function and daily activities. In this case, flexor tendon impingement with radiocarpal ligament injury due to osteophyte formation was unique as commonly this is due to overuse and irritation. Addressing this underlying cause was essential for guiding treatment, focusing on both symptom management and the mechanical factors that exacerbated the condition. Conservative management including bracing, corticosteroid injection, and rehabilitation was prioritized. Further imaging or regenerative treatments would be considered based on clinical progress.

Conclusions: A multimodal rehabilitation approach, involving targeted therapy and selective injections, effectively manages radiocarpal ligament injuries. Early intervention and structured follow-up optimize recovery and timely return to activity.