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Wrist Imaging Upper Extremity Trauma: page 1 of 14 Wrist Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist Arm: Radius rotates around ulna 3D Wrist CT Radius: [L] “ray” (radial head) Anatomy Anatomy Wrist: Radius is the foundation upon Radiographs Radiographs 4 Views 4 Views which the carpal bones reside Looking down on Lister’s Tubercle (dorsal) CT/MR CT/MR articular surface Normal anterior (volar) Scaphoid FOOSH FOOSH Fossa Lunate (palmar) tilt of distal radius Colles Colles Fossa Radial Normal Perpen- Torus Torus Styloid 2-20° dicular to Barton Barton volar long axis Scaphoid Scaphoid Anterior Long axis of Frontal Ulna side Frontal Ulna side radius WOW view view WOW view R view R www.schreibman.info www.schreibman.info © 2015 Ken L Schreibman, PhD/MD Slide 1 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 2 of 84 Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist aka “Navicular of hand” Should have opening up Scaphoid:[Gr]“boat” (confusing Navicular in foot) Lunate:[L] “moon” Like a teacup holding tea Anatomy Scaphoid bridges the proximal and Anatomy Lunate sits ½ over radius (lunate fossa), Radiographs Radiographs 4 Views distal carpal rows 4 Views ½ over Triangular Fibro Cartilage (TFC) Lunate is nearly surrounded by cartilage CT/MR Distal Waist CT/MR Distal Pole Lunate susceptible FOOSH Pole S Waist Distal pole sticks S FOOSH S to AVN (Kienböck) S Colles out anteriorly Colles Torus Proximal Torus L One Proximal One L small Barton Scaphoid Pole Barton Scaphoid TFC small Fossa Pole Fossa artery Scaphoid Scaphoid Lunate artery posterior Fossa anterior Frontal Ulna side Frontal Ulna side WOW view R view R WOW view R view R www.schreibman.info www.schreibman.info © 2015 Ken L Schreibman, PhD/MD Slide 3 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 4 of 84 Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist [L] “arm”… related to “ell”, “cubit” * Proximal Carpal Row:(S+L+Tq+P) Ulna:[L] “elbow” Unit of length equal to the forearm Anatomy Triquetrum (Tq): [L] “three-cornered” Anatomy Ulna major component of elbow, forearm Radiographs Radiographs 4 Views Pisiform (P): [L] “pea” 4 Views Role at wrist is limited PT Jt Doesn’t even normally touch carpal bones CT/MR Radio- Distal CT/MR Forms the ½ Radius fxs have FOOSH Carpal Pole FOOSH Ulnar styloid fxs** Joint S P P Distal S P Often remain P Colles Tq Pisiform Tq Colles Radio- Tq ununited Tq Torus L stick out Torus Ulnar L Seldom require Barton LT Jt L Barton surgery L TFC anterior Joint TFC Ulna Scaphoid SL Jt Scaphoid (If DRUJ stable) Styloid Ulna Frontal Ulna side Frontal DRUJ Styloid Ulna side WOW view R view R WOW view R U view U www.schreibman.info www.schreibman.info *www.etymonline.com © 2015 Ken L Schreibman, PhD/MD Slide 5 of 84 © 2015 Ken L Schreibman, PhD/MD **orthopedics.about.com Slide 6 of 84 ©Ken L Schreibman, PhD/MD 10/27/15 www.schreibman.info Upper Extremity Trauma: page 2 of 14 Wrist Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist Head-shaped round proximal end Hook-shaped process (H) Capitate:[L] “head” sits inside open end of the lunate Hamate:[L] “hook” sticks out anterior Anatomy Anatomy Hook of Hamate Radiographs Radiographs sticks out 4 Views 4 Views H anteriorH C C C CT/MR Capitate CT/MR Distal Pole FOOSH S P Lunate P FOOSH S P P Colles Tq Radius Tq Colles Tq Tq Torus form a Torus Pisiform L L L L Barton TFC straight Barton TFC Scaphoid stack Scaphoid Frontal Ulna side Frontal Ulna side WOW view R U view RU WOW view R U view U www.schreibman.info www.schreibman.info © 2015 Ken L Schreibman, PhD/MD Slide 7 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 8 of 84 Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist Capitate articulates with Long finger MC Metacarpals Hamate articulates with Ring & Small finger Trapezoid:[Gr] “table shaped” 2 parallel sides Anatomy Anatomy Radiographs Radiographs 4 Views 4 Views H H Td H H C C aka “Lesser CT/MR CT/MR Trapezoid Multangular” FOOSH S P P FOOSH articulates S P P Colles Tq Tq Colles Tq Tq Torus Torus with index L L finger MC L L Barton TFC Barton TFC Scaphoid Scaphoid Frontal Ulna side Frontal Ulna side WOW view R U view U WOW view R U view U www.schreibman.info www.schreibman.info © 2015 Ken L Schreibman, PhD/MD Slide 9 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 10 of 84 Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist no parallel Trapezium:[Gr] “little table” sides Carpal Tunnel Anatomy Anatomy Walls of the carpal tunnel are made of Radiographs Radiographs the carpal bones that stick out anteriorly 4 Views H H 4 Views Tm Td C aka “Greater Tm CT/MR Multangular” CT/MR Tm S H P FOOSH TrapeziUM S P P FOOSH Colles articulates Tq Tq Colles Torus with the Torus L L Barton ThUMb TFC Barton Scaphoid Scaphoid Frontal Ulna side WOW view R U view U WOW www.schreibman.info www.schreibman.info © 2015 Ken L Schreibman, PhD/MD Slide 11 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 12 of 84 ©Ken L Schreibman, PhD/MD 10/27/15 www.schreibman.info Upper Extremity Trauma: page 3 of 14 Wrist Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist Hand ≠ Wrist Hand ≠ Wrist Anatomy Hand Hand Hand Anatomy Wrist Wrist Wrist Radiographs PA Obl Lat Radiographs PA Obl Lat 4 Views 4 Views Wrist Ul Dev CT/MR CT/MR FOOSH FOOSH Colles Colles Torus All Negative Torus Still Negative… Barton Barton Scaphoid Scaphoid WOW WOW Bennett Fracture! www.schreibman.info R,A 27yoM, fell off bike www.schreibman.info R,A 27yoM, fell off bike © 2015 Ken L Schreibman, PhD/MD Slide 13 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 14 of 84 Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist Hand ≠ Wrist Hand vs Wrist: X-ray Beam Anatomy PA Hand PA Wrist (next day) Anatomy Hand radiographs: Wrist Radiographs Radiographs X-ray beam centered radiographs: 4 Views 4 Views @ 3rd MC head X-ray beam CT/MR CT/MR centered @ FOOSH FOOSH capitate Colles Colles Torus ? Torus Barton Barton Scaphoid ! Scaphoid WOW WOW www.schreibman.info G,M 44yoM www.schreibman.info G,M 44yoM © 2015 Ken L Schreibman, PhD/MD Slide 15 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 16 of 84 Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist Wrist: PA = Standard View Wrist: PA View Anatomy Elbow @ Anatomy PA: Standard view Carpal Alignment Radiographs shoulder height X-ray beam Radiographs 4 Views Elbow @ 90° PosteriorAnterior 4 Views Proximal Carpal Row = “PA” Joint Alignment C-MC CT/MR Raise CT/MR Radio-Carpal Joint FOOSH cassette FOOSH R-C Jt Colles Shield Colles Ulna Carpal-Metacarpal Jt Torus X-rays Torus shorter Distal Radio-Ulnar Jt Barton Barton than Low Ulnar Length Scaphoid chair Scaphoid Radius X-ray beam centered DRUJ Normally, Ulna same length as Radius WOW on Capitate WOW www.schreibman.info www.schreibman.info D,H 21yoF © 2015 Ken L Schreibman, PhD/MD Marty age 15 Slide 17 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 18 of 84 ©Ken L Schreibman, PhD/MD 10/27/15 www.schreibman.info Upper Extremity Trauma: page 4 of 14 Wrist Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist Ulnar Variance Wrist: Lateral View Anatomy Ulna shorter than Radius Ulna longer than Radius Anatomy Radiographs “Negative Ulnar Variance” “Positive Ulnar Variance” Radiographs 4 Views Risk AVN Lunate (Kienböck) Ulna can punch hole in TFC 4 Views AVN Lunate Ulna can impact upon Lunate CT/MR with collapse “Ulna Abutment Syndrome” CT/MR C C FOOSH FOOSH Colles Colles Torus Torus L L Barton Barton Scaphoid 2Premature y earlier, Treated Scaphoid Anterior R R Ulna is only fusionnormal radius, with ulna Normal continuedunfused shortening slightly shorter ulnagrowth growth Compared to osteotomy 2-20° WOW than Radius Radius shortening plates UV normal side WOW volar www.schreibman.info S,Z 18yoM T,C 14yoM www.schreibman.info C,S 48yoM © 2015 Ken L Schreibman, PhD/MD Slide 19 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 20 of 84 Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist Can see most carpal bones on Lateral Triquetral Fracture Anatomy Can’t see Anatomy Classically presents Radiographs Triquetrum on Radiographs 4 Views lateral view… 4 Views as a tiny avulsion fracture dorsal to CT/MR C SP C CT/MR Fx the mid-carpus FOOSH S Tq FOOSH Colles P Colles There are no normal Torus L L Torus ossicles dorsal to the Barton Barton carpal bones Scaphoid R R Scaphoid If you see a small bone Hard to see Ulna as it U back there, it’s a fracture overlaps Radius on a May be old, as these tiny WOW good lateral view WOW fractures don’t always heal www.schreibman.info C,S 48yoM www.schreibman.info M,G 50yoM © 2015 Ken L Schreibman, PhD/MD Slide 21 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 22 of 84 Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist Wrist: Standard 3 Views Wrist: Oblique View Anatomy PA View Oblique View Lateral View Anatomy Best view of: Radiographs Radiographs 4 Views 4 Views STT joint MC Thumb C-MC joint CT/MR CT/MR Td Common sites for OA FOOSH FOOSH Tm Colles Thumb Colles S Additional view of: Torus Down Thumb Torus Carpals (scaphoid) Barton Thumb Up Barton Metacarpals Scaphoid Halfway Scaphoid Radius (styloid) Between Sometimes a fracture is WOW WOW seen only on this view www.schreibman.info www.schreibman.info K,M 20yoF © 2015 Ken L Schreibman, PhD/MD Slide 23 of 84 © 2015 Ken L Schreibman, PhD/MD Slide 24 of 84 ©Ken L Schreibman, PhD/MD 10/27/15 www.schreibman.info Upper Extremity Trauma: page 5 of 14 Wrist Upper Extremity Trauma Wrist Upper Extremity Trauma Wrist Scaphoid (Ulnar Deviation) View 4 View Series for Scaphoid Fracture Anatomy Patient holds LateralAnatomy PA View Oblique View Scaphoid Radiographs wrist in ulnar ViewRadiographs View 4 Views deviation 4 Views CT/MR CT/MR FOOSH Yields an FOOSH Colles Colles Dorsal ? Torus elongated Torus swelling Barton view of the Barton Scaphoid scaphoid.
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