Sometimes a Long Way to Go: Symptomatic Subtle Nonosseous Capitotrapezoid Coalition. Case Report and Literature Review

A carpal coalition is an abnormal articulation between carpal bones due to inadequate segmentation of common embryological precursors. It is often seen as an incidental and asymptomatic finding. Here we illustrate the clinical and radiologic characteristics of a subtle partial and symptomatic capitotrapezoid coalition in a 30-year-old female patient. The clinical symptoms and imaging findings had been present but were not recognized for > 10 years before the diagnosis. After the correct diagnosis and resection of the coalition, the patient was free of symptoms and able to continue her profession as a physical therapist. · Subarticular bone marrow edema pattern (BMEP) may represent the only magnetic resonance imaging (MRI) finding indicating a potential nonosseous coalition, particularly when the coalition is subtle.. · Subarticular BMEP that remains constant in location across several imaging studies over time strongly suggests a nonosseous coalition, particularly in the absence of other discernible MRI abnormalities.. · High-resolution computed tomography (CT) is the imaging standard of reference to diagnose discrete nonosseous coalitions, especially when initial MRI is suggestive but not definitive.. · Patients typically present with a long-standing history of insidious onset, often in adolescence or early adulthood, characterized by recurrent episodes of otherwise nonspecific exercise-related pain..