Wrist and Hand

Name the carpals

What are the recommended projections

PA

lateral

oblique

What are some additional views for the wrist

• ulnar deviation PA

• radial deviation PA

• carpal tunnel view

• closed fist view

What view is this

PA wrist

What view is this

PA wrist

What is 1

capitate

What is 16

trapezoid

What is 15

trapezium

What is 12

scaphoid

what is 6

lunate

what is 17

triquetrum

what is 8

pisiform

what is 18

ulna

what is 10

radius

what is 4

hamate

What is a negative ulnar variance

ulna sits below/shorter than radius

What is a positive ulnar variance

ulna sits above/longer than radius

What can ulnar variances cause

more stress on areas of the wrist

where is stress localized with a positive ulnar variance

ulnar side

where is stress localized with a neutral ulnar variance

throughout whole hand/wrist

where is stress localized with a negative ulnar variance

radial side

purpose of an oblique wrist view

gives better visualization of hamate, triquetrum, and trapezium

What view is this

oblique wrist

What view is this

oblique wrist

What is 1

1st met

What is 2

scaphoid

What is 3

pisiform

What is 4

triquetrum

What is 5

What is 6

What is 7

What is 8

What is 9

What is 10

What is 11

What is 12

What is 13

what view is this?

lateral wrist

optional view of the wrist

• radial deviation

• ulnar deviation

• clenched fist view

• carpal tunnel view

What view is this

radial deviation

What view is this

radial deviation

what does the radial deviation show best

• lunate

• triquetrum

• hamate

• hamate

• pisiform

What view is this

ulnar deviation

What does the ulnar deviation best show

• scaphoid fractures

• scapholunate dislocations

What view is this?

clenched fist view

What’s another name for clenched fist view

stress view PA

What is the clenched fist view used for

identify scapho-lunate dissociations

What does this image show

gap between the scaphoid and lunate

purpose of the carpal tunnel view

the space for the nerves/tendons in the carpal tunnel

What can the carpal tunnel view be helpful in seeing

hook of hamate

What is this view

carpal tunnel view

what view is this

carpal tunnel view

Where are the carpals

carpals in children are cartilaginous

standard views of the hand

• PA

• lateral

• oblique

additional views for hand

too many

What view is this

PA hand

What view is this

PA hand

What view is this

lateral hand

What view is this

lateral hand

the lateral hand view has what view of the thumb

PA

What view is this

oblique hand

What view is this

oblique hand

What type of fx is this

bennett

when does a Bennett fx occur

fx-dislocation resulting from axial blow to the partially flexed metacarpal

define a Bennett fx

base of the metacarpal dislocates and an avulsion fx to the ant lip of the base of the thumb occurs

What patho is being shown

nonunion of scaphoid due to poor perfusion

What fx is this

Colles’ fx

initial image according to the ACR guideline for traumatic wrist and hand

XR

next steps if there is trauma or unclear dx according to the ACR

repeat radiograph 10-14 days

MRI

CT

next steps if there is wrist tendon/lig trauma according to the ACR

MRI

MR arthrogram

CT arthrogram

Dx US

next steps if there is DRUJ or carpal malalignment (no fx) according to the ACR

CT

MR

MR arthrography

next steps if there is MCP, PIP, DIP malalignment (no fx) according to the ACR

MRI

Dx US