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A 59-year-old woman presents with a longstanding painful swelling on the dorsal side of the right wrist. No symptoms in other joints. No history of trauma, infection, or tumor.
Examination findings
A rough, non-displaceable resistance at the dorsal carpal region is palpable. Extension is severely limited, making a fist is only partially possible, all laboratory values are within the normal range.
The x-ray shows several ossicles on the dorsal side of the wrist, some of which are synostosed with the carpals on CT. In addition, cystic inclusions with marginal sclerosis are seen in the carpals and in the ulnar head.
What would you suspect, and what further examination would you recommend?
