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