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Clinical Imaging > Hand, Wrist and Forearm 2 > Flashcards

Hand, Wrist and Forearm 2 Flashcards

1
Q

Why when assessing an X-ray would you look at the lines of measurement?

A

Because it allows us to see progression or regression of an injury

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2
Q

What is the metacarpal sign?

A

A line drawn along the heads of the 4th and 5th metacarpals will intersect the head of the 3rd metacarpal if shortening is present.
The shortened 4th metacarpal is the key to the sign

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3
Q

What is the metacarpal index used for?

A

It is used to confirm the presence of disproportionate metacarpal length

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4
Q

What is the metacarpal index no longer used for?

A

No longer used for the diagnosis of Marfan syndrome due to low sensitivity and specificity

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5
Q

What is Gilula’s Arc of Alignment?

A

PA wrist radiograph to assess normal alignment of carpal bones

The three arcs are smooth curves outlining
Proximal convexities of the scaphoid, lunate and triquetrum
Distal Concave surfaces of the scaphoid, lunate and triquetrum
Follows the main proximal curvatures of the capitate and hamate

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6
Q

What is a positive score on the metacarpal index?

A

anything above 8.4

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7
Q

What can misalignment of Gilula’s Arc of Alignment indicate?

A

Fracture or ligament injury

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8
Q

Joint space between the carpal bones should not exceed…

A

2mm

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9
Q

What is the normal value of the carpal angle?

A

130-137 degrees

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10
Q

What could a carpal angle of over 139 degrees indicate?

A

Bone Dysplasia
Down Syndrome
Pfeiffer Syndrome

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11
Q

What is an anatomical variant?

A

atypical finding that is seen in a percentage of the population, which generally has no clinical significance, and is considered within the spectrum of normal findings.

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12
Q

What are nutrient channels/foramina?

A

a small tunnel through the cortex of a long bone containing a nutrient artery which supplies the bone

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13
Q

What does nutrient channels/foramina look like on an x-ray?

A

radiolucent line passing through the cortex into the medullary portion of the diaphysis of the bone.

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14
Q

What are accessory ossicles?

A

secondary ossification centres that remain separate from the bone
Typical locations in the body
Congenital or acquired (trauma or degeneration)
Small, round, bony structures with smooth cortical margins in typical locations

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15
Q

What do accessory ossicles look like on an x-ray?

A

Small, round, bony structures with smooth cortical margins in typical locations

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16
Q

What is the cortex on an x-ray?

A

Outline of the bone

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17
Q

What are foramina?

A

Holes

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18
Q

Where are the most common sesamoid bones in the hand?

A

Pisiform
1stMCP joint sesamoid(two)
reported incidence of 100%
1stIP joint sesamoid
2ndMCP joint sesamoid
5thMCP joint sesamoid
Less commonly  3rd& 4thMCP joints

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19
Q

What is a sesamoid bone?

A

Embedded within tendon or muscle
Helps modify pressure, reduce friction, alter direction of muscle pull
Form in response to strain / Anatomical Variant
Small, round, bone opacities, smooth cortical edges in muscle or tendon

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20
Q

Which ‘H’ is an accessory ossicle in wrist?

A

Os Hamuli Proprium

21
Q

Where is Os Hamuli Proprium located?

A

Hook of Hamate

22
Q

What ‘O’ is an accessory ossicle?

A

Os Triangulare

23
Q

Where is Os Triangulare located?

A

between theulnar styloid,lunateand triquetrum

24
Q

What ‘T’ is an accessory ossicle?

A

Os Trapezium Secondarium

25
Q

Where is Os Trapezium Secondarium located?

A

between the 1stand 2nd metacarpal bases on lateral and oblique hand radiograph

26
Q

What ‘E’ is an accessory ossicle?

A

Os Epilunate

27
Q

Where is Os Epilunate located?

A

dorsal/posterior surface of the lunocapitate articulation

28
Q

What ‘L’ is an accessory ossicle?

A

Lanula

29
Q

Where is the Lanula located?

A

in theTFCC (Triangular fibrocartilage complex, between the tip of the ulna styloid process and thetriquetrum.

30
Q

What ‘S’ is an accessory ossicle?

A

Os Styloideum

31
Q

Where is the Os Styloideum located?

A

between 2ndand 3rdmetacarpal bases

32
Q

What is polydactyly?

A

More than the usual number of digits in the hand or feet

33
Q

What type of polydactyly is the most common?

A

Postaxial - 1 in 3000 people

34
Q

What caused polydactyly?

A

Congenital,
genetic mutation,
environmental cause.
Treated with surgical intervention

35
Q

What is syndactyly?

A

Fusion of 2 or more digits

36
Q

What digits are the most common to be fused in patient’s with syndactyly?

A

2nd and 3rd digits

37
Q

What is Symphalangism?

A

Ankylosis of the interphalangeal joints (fusion)
Stiffness of the joints, lack of skin folds, reduced range of movement

38
Q

What causes Symphalangism?

A

failure of differentiation of the interphalangeal joint, normally occurs ~ 8th week of foetal development

39
Q

What is Kirner Deformity?

A

curvature of the 5th distal phalanx of both phalanges, a palmar/anterior and radial direction

40
Q

What does Kirner Deformity look like on an x-ray?

A

Usually bilateral
Affects distal 5th phalanx
Palmar/anterior and radial deviation
radiolucent nidus (1-2 mm) within the terminal tuft
shortened diaphysis
sclerosis of the diaphysis
metadiaphyseal defect

41
Q

What is Marfan Syndrome?

A

Multisystem connective tissue disease affecting 1 in 5,000 people

42
Q

What does Marfan’s syndrome look like on an x-ray?

A

arachnodactylyl (Spider-like)
Flexion deformity of little finger

43
Q

What is Madelung deformity?

A

Bowing deformity and subluxation of the distal radio-ulnar joint

44
Q

What causes Madelung Deformity?

A

Congenital
Growth plate trauma (acquired)

45
Q

What is Carpal Coalition?

A

failure of separation of two or morecarpal bones during intrauterine development
most common bones are - lunate and triquetrum

46
Q

What is bipartite scaphoid?

A

Divided carpus
Can be unilateral or bilateral

47
Q

What causes bipartite scaphoid?

A

Controversy over whether it is congenital (i.e. normal variant) or post-traumatic

48
Q

What is negative/positive ulna variance?

A

The ulna is abnormally shortened (negative) or elongated (positive) compared to the radius

49
Q

How do you check for ulna variance?

A

draw 2 lines
1 line across the articular surface of the ulna
1 line across the lunate fossa of the radius
measure the distance between these 2 lines (normal is 0mm)
if the ulnar line is distal to the radial line = positive UV
if the ulnar line is proximal to the radial line = negative UV

Clinical Imaging (22 decks)

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