DIBA - Wrist and Hand

what are the views in the finger series?

PA, lateral, oblique, finger stress view

T/F: the ENTIRE hand must be visible to be considered a diagnostic hand series

true

ball catcher's

good for evaluating the pisiform and metacarpal heads

why may the metacarpals simulate pathology?

- 2nd and 3rd metacarpals often have a thicker cortex - 5th metacarpal may appear wider

why may we want to take a CT of the hand/wrist?

- assess the extent of complex fractures of the wrist - assess for occult fractures - evaluate the progress of fracture healing

lateral hand

- can be done with or without the fingers spread - good for evaluating dorsal/ventral aspects of the finger joints for subtle pathology

why may the first MCP mimic pathology?

- its normal position suggests lateral subluxation, but it is normal to have up to 40% offset - compare bilaterally

nutrient canals

- point away from end of active growth - in carpals, may see en face appearing as small, well defined lucencies

scaphoid tubercle

- small outgrowth on the lateral aspect of the scaphoid - misinterpreted as cortical "buckling" secondary to fracture

ulnar deviation

- stresses the scaphoid, helping in detecting subtle fractures - evaluates carpal motion and intercarpal joint integrity

carpal tunnel

- used to evaluate the tunnel for size and SOLs - evaluates the borders of the tunnel

lateral wrist

best for evaluating carpal alignment and anterior/posterior soft tissues

oblique wrist

best for evaluating first carpal-metacarpal area and the lateral carpals

PA wrist

best for evaluating overall anatomy

where are we likely to see remnant growth plates in the wrist/hand views?

distal radius

angulated scaphoid

further evaluates for scaphoid fractures by elongating the bone

PA hand

good for assessing general anatomy

oblique hand

may demonstrate pathology not seen on first 2 views

scaphoid ring

sclerotic ring seen on P-A view if the scaphoid is mildly rotated due to improper positioning or subluxation