Week 11 - Wrist and Hand Imaging
Asynch: This is a PA radiograph of the left hand. 1. This joint has septic arthritis. Which joint is circled? 2. What anatomical structure is marked with the X? 3. Which phalanx should be aligned with the radius?
1. 3rd proximal interphalangeal joint 2. 4th proximal phalanx 3. 2nd phalanx
Asynch: 1. Which metacarpal base has the white diamond on it? 2. The white arrow shows widening between two bones in the proximal row of carpal bones. This is commonly called the Terry Thomas sign. There is a space between which two carpal bones? 3. The 4 is on what carpal bone? 4. The 3 is on what anatomical structure? 5. How would you describe the ulnar variance of the figure on the right? 6. The angle on the normal radiograph with the 2 is called the _____ angle.
1. 4th 2. Scaphoid and lunate 3. Capitate 4. Ulnar Styloid 5. Neutral 6. Radial articular angle
Asynch: 1. What joint is involved? 2. How would you describe the displacement?
1. 5th DIP joint 2. Dorsal
Asynch: This is a lateral radiograph of the right wrist. 1. Which line is showing the angle of the lunate? [blue or yellow] 2. Which line is showing the angle of the scaphoid? [blue or yellow] 3. Is this angle abnormal? 4. Is the angle of relationship between the radius and the lunate (radiolunate angle) normal or abnormal?
1. Blue 2. Yellow 3. Yes 4. Abnormal
Asynch: This is a wrist PA radiograph without deviation. 1. The white lines show a malalignment of his carpal arcuate line. [I, II, or III] 2. The yellow lines show a malalignment of his carpal arcuate line. [I, II, or III]
1. I 2. II
Asynch: 1. What type of deformity do you see in the small finger of the left hand? 2. This finger has flexion at the PIP joint and hyperextension at the DIP joint. What is the name for this deformity? 3. What type of deformity do you see in the ring finger of the left hand?
1. Mallet finger 2. Boutonniere deformity 3. Swan neck deformity
Asynch: This is an oblique view of a wrist. 1. Which hand is this? 2. The blue arrow is pointing to osteoarthritis in this joint. What two bones are articulating here? 3. What other carpal bones does the trapezium articulate with?
1. Right 2. Base of 1st metacarpal and trapezium 3. Trapezoid and scaphoid
Asynch: These are coronal MR images of the wrist. 1. Image A is a fat-sensitive image. [True or False] 2. In image B, are the yellow arrows pointing to edema along the ulnar or radial aspect of the wrist? 3. Image B is a fat-sensitive image. [True or False]
1. True 2. ulnar 3. False
Asynch: These are both PA views of a right wrist. 1. The image on the left is taken with the wrist in a deviated position. Is this right wrist in radial or ulnar deviation? 2. The blue arrow is pointing to a radiolucent line, which indicates a fracture through which carpal bone?
1. ulnar 2. scaphoid
Asynch: This is a PA and oblique view of the hand. Can you see the disruption in alignment? What anatomy is involved?
5th metacarpal head fracture
Lateral Wrist View Spatial Alignment: Capitolunate Angle
Angle of Lunate
Lateral Wrist View Spatial Alignment: Scapholunate Angle
Angle of Scaphoid
Wrist PA View Orientation
As if you are looking at your own hands, wrist up
Hand Oblique View
Better view of articulation of metacarpal + trapezium trapezium + scaphoid trapezium + trapezoid
Wrist Lateral View
Better view of the alignment of the radius + carpal bones
Wrist Oblique View Structures: Joints Spaces
Blue: 1st CMC Yellow: Scaphoid-trapezium Red: Trapezium-trapezoid
Hand PA View
CR: Through head of the 3rd MCP Joint
Wrist Oblique View Orientation
Looking at your hands, fingers up
Lateral Wrist View Orientation
Looking at your own hands
Wrist PA Anatomy with Ulnar Deviation
Scaphoid view
Asynch: How would you describe the displacement of this fracture?
Volar apex or dorsally displaced fracture The apex of the fracture is volar and the displacement should describe how the DISTAL fragment is displaced in relation to the proximal portion.
Asynch: Are both these fractures dorsally displaced?
Yes
What is Triangular Fibrocartilaginous Complex (TFCC)?
meniscus of the wrist. large surface = radius smaller surface = ulna
