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