Wrist & Hand Flashcards
S2Q4
WH
most what d/t (2) which is d/t (2)
most dislocated, fx, ligaments injury attachment (2)
epiphyseal plate - tx
- most radiographed d/t usual trauma & degeneration d/t microtrauma & arthritic
- most dislocated: lunate
- most fx: scaphoid
- ligaments: most injuries are attached to lunate or TFCC
- epiphyseal plate: don’t use US
WH
if indiv finger
ideal views (3)
- if indiv finger = indiv exam
- ideal: AP, lat, oblique
WH: Radio
PA of hand - best (3), how, sign, overlapping (2G)
- best: hand, wrist, distal forearm
- how: palm down
- overlapping: trapezoid x trapezium, pisiform x triquetrum
- MCP sign: line drawn on distal articulating of 5th-3rd MCP
WH: Radio
oblique hand - not see (1), how (1=2)
oblique wrist - not see (1), how, best (4) + (3G)
OBLIQUE HAND
- NOT see: wrist
- how: foam to maintain 45 deg = avoid shortening phalanges & bye IPJ
OBLIQUE WRIST
- NOT see: all joints
- how: 45 rot from PA
- best: scaphoid, trapezium, 1st CMC carpals
carpals
- hamate: body yes, hook no
- dorsal triquetrum
- trapezium + attachments to CMC scaphoid trapezoid
WH: Radio
lateral of hand - see (2), central ray
lateral of wrist - cons, how, volar tilt, (2) angles
LATERAL OF HAND
- see: sesamoid, true AP of thumb
- ray: 2nd MCPJ
LATERAL OF WRIST
- volar tilt/palmar inclination/radial tilt: 16-25 = assess radial fx
- scapholunate = 30-60
- capitulolunate = < 20
- how: ulnar on table
- superimposed but can still easy detect displacement fx
WH: Radio
PA of wrist - see, how, angle + indication, arcuate lines (3.3.2)
- see: til middle & distal MCP
- how: palm down
- radial angle: 10-15 (if less = fx)
arcuate lines
- arc I: proximal convex surface of scaphoid lunate triquetrum
- arc II: distal concave
- arc III: prox convex of capitate & hamate
WH: Radio
UD of wrist - see (2) + d/t, how, for
RD of wrist - see + d/t, best (4)
UD OF WRIST
- see: scaphoid & opened intercarpal radial spaces
- scaphoid = elongated d/t roasted distal pole towards ulna
- how: palm down
- for: subtle scaphoid fx
RD OF WRIST
- best: lunate, triquetrum, pisiform, hamate
- scaphoid = shortened d/t towards radius
WH: Radio
carpal tunnel - see (2), for (2)
- optional
- see: carpal bones, hook of hamate
- for: median nerve & flexor tendon problems
WH: Radio
conventional (2)
CT (2)
CTa (1)
MRI (6)
MRa (3)
US (7)
protocol
if joint ax
- conventional: 1st, r/o abnormal
- CT: complex fx, distal RU sublux
- CT arthrography: sub for MRI in TFCC
- MRI: soft tissue, TFCC, ligament tear, occult fx, avascular, ulnocarpal impaction
- MR arthrography: TFCC peripheral tear, scapholunate lunotriquetral tear
- US: ganglia, tenosynovitis, tendon rupture, CTS, TFCC thickness, scapholunate lunotriquetral
- protocol: distal RU metaphysis to MCP base
- use both soft tissue & bone windowing for joint ax
WH: Radio - CT Scan
scaphoid imaging - how
distal RUJ - how + check (2)
SCAPHOID IMAGING PROTOCOL
- in UD to align long axis c gantry
DISTAL RUJ STABILITY
- both forearms SUP = compare ulna in radial notch or ulna sublux
WH: Radio - CT
bone density - pathology + 2 types + where usually found + signal in MRI
bone density
- osteonecrosis: scaphoid (preiser’s), lunate (kienbock)
for MRI it’s in proximal pole, low signal
WH: Radio - CT
cartilage/space - check (1), late what = (1), degenerative what is d/t what, for (3)
soft tissue - most common pathology
CARTILAGE/JOINT SPACE
- check: articular fx
- late effect of tx = altered joint alignment
- degenerative lesions: d/t excessive strain
- for: radioscaphoid arthritis, ulnocarpal impaction, hamolunate impingement
SOFT TISSUE
- most common: ganglion cyst
WH: Radio - MRI
further clarify (3)
use what - purpose, see what
- further clarify: RA, infection, neoplasm
microscopy surface coil
- smallest = better resolution
- see small shit (TFCC)
- dec need for MRA
WH: Radio - MRI
alignment - pathology + d/t
bone signal - check (1)
cartilage - TFCC best view, use what, pathology + d/t (1=1)
edema - what, d/t
ALIGNMENT & ANATOMY
- scapholunate dissociation: common malalignment d/t torn ligaments
BONE SIGNAL
- check: marrow edema
CARTILAGE
- TFCC: best in coronal
- ulnolunate impaction: d/t chronic abutment of ulna on lunate = degeneration
- use fat suppressions to highlight
EDEMA
- footprint
- d/t inflammation
WH: Radio - MRI
soft tissue (ligaments) - extrinsic, intrinsic, volar, interroseous, which carpals has most ligament attachments, signal
- extrinsic: RU to carpals, carpal to MCP
- intrinsic & interosseous: between carpals
- volar lig: key wrist stabilizer
- capitate & lunate = most attached ligaments to carpals
- low signal
WH: Radio - MRI
soft tissue (tendon) - effect thing how + signal, tendon sheath what + if inflamed then what & signal
magic angle effect
- tendon 55 to magnetic field = intermediate signal
tendon sheaths
- specialized tubular bursa
- inflammation = fill circumferentially = high signal on T2
WH: Radio - MRI
soft tissue (neural) - 3 nerves best veiw, signal
soft tissue (muscle) - signal
SOFT TISSUE ON NEURAL
- median radial ulnar: best in cross-sectional on axial
- intermediate signal
SOFT TISSUE ON MUSCLE
- intermediate signal
WH: Conditions
when, for (3)
immob - position (2), stable unstable avulsion complete
- 7-10d after
- confirm, justify removal of fixation, permit to rehab
immobilization
- intrinsic or MCP 70 EXT; otherwise distracted & no union
- stable: 3-4w
- unstable: 4-6w
- avulsion: 6-8w
- complete healing: +2w
WH: Conditions
phalangeal fx - MOI (1), types (3)
MCP fx - types (4) + most common, boxer’s fx what
thumb MCP fx - which type most common, bennet MOI, rolando, gamekeeper MOI (2)
PHALANGEAL FX
- MOI: crash
- types: stable, unstable, intraarticular
MCP FX
- types: head, neck, base, shaft
- boxer’s fx = 5th MCP
thumb
- base most common
- bennet: axial load on partially flexed thumb
- rolando: comminuted version
- gamekeeper: hyperextension/avulsion on MCP ulnar collateral ligament
WH: Conditions
hamate fx - MOI (2.1), extra structure affect + effect
radial head fx - name, structure (2)
ulnar styloid fx - structure/d/t
HAMATE FX
MOI
- body: direct crush, forces from 5th MCP
- hook: athletic; more common
- ulnar nerve = paresthesia, bye intrinsic muscles
RADIAL HEAD FX
- essex-lopresti
- affects DRUJ & interosseous membrane
ULNAR STYLOID FX
- d/t TFCC attachments
WH: Conditions
scaphoid fx - MOI (1), common d/t (3), types (3) + vascularity + which most common
- MOI: FOOSH
- common d/t: receives compression from capitate, links carpals, stops dorsiflexion/ext of wrist
types
- proximal pole: poor blood, where necrosis starts
- middle pole/waist: most common
- distal pole
WH: Conditions
lunate distal radial head fx - name, MOI (1), seen when, stages (3.3.4.4)
- kienbock’s disease
- MOI: fall or punch on extended wrist
- seen when avascular necrosis occurs
stages
- stage 1: normal radiograph, tomography has linear fx, MRI confirm vascular
- stage 2: cystic, sclerosis, fx line
- stage 3: cystic resorption, sublux capitate, lunate collapse, bone density change
- stage 4: complete collapse, fragmentation, arthritis, lunate down into radius
WH: Conditions
triquetrum fx - MOI (1), pisiform what
pisiform fx - MOI (2)
trapezium fx - MOI (2), sx (3)
trapezoid fx - MOI (1)
capitate fx - trend
TRIQUETRUM FX
- MOI: blow to hypothenar
- pisiform: sesamoid of FCU
PISIFORM FX
- MOI: avulsion d/t torn ligament, trauma to ulnar wrist
TRAPEZIUM FX
- MOI: axial load on adducted thumb, fall on extended wrist
- sx: joint pain, thumb weakness, LOM
TRAPEZOID FX
- MOI: axial load on 2nd MCP
CAPITATE FX
- rarely isolated since protected position
WH: Conditions
distal radial head fx - MOI (1), who (3), radial angle + indication/structures (4), colle’s smith barton galleazi what + portion
- MOI: FOOSH
- post-menopausal women, protective injuries, children (highest type)
- radial angle: < 15 = impaction of radius scaphoid lunate, radial shortening, radiocarpal joint
types
- colle’s fx: to dorsal, distal portion
- smith’s: to dorsal, distal portion
- barton’s: volar & dorsal rim
- galleazi: middle & distal portion; DRUJ
