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IMAGING > Wrist & Hand > Flashcards

Wrist & Hand Flashcards

S2Q4

1
Q

WH

most what d/t (2) which is d/t (2)

most dislocated, fx, ligaments injury attachment (2)

epiphyseal plate - tx

A
  • 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
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2
Q

WH

if indiv finger

ideal views (3)

A
  • if indiv finger = indiv exam
  • ideal: AP, lat, oblique
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3
Q

WH: Radio

PA of hand - best (3), how, sign, overlapping (2G)

A
  • 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
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4
Q

WH: Radio

oblique hand - not see (1), how (1=2)

oblique wrist - not see (1), how, best (4) + (3G)

A

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

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5
Q

WH: Radio

lateral of hand - see (2), central ray

lateral of wrist - cons, how, volar tilt, (2) angles

A

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
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6
Q

WH: Radio

PA of wrist - see, how, angle + indication, arcuate lines (3.3.2)

A
  • 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

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7
Q

WH: Radio

UD of wrist - see (2) + d/t, how, for

RD of wrist - see + d/t, best (4)

A

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

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8
Q

WH: Radio

carpal tunnel - see (2), for (2)

A
  • optional
  • see: carpal bones, hook of hamate
  • for: median nerve & flexor tendon problems
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9
Q

WH: Radio

conventional (2)
CT (2)
CTa (1)
MRI (6)
MRa (3)
US (7)

protocol

if joint ax

A
  • 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
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10
Q

WH: Radio - CT Scan

scaphoid imaging - how

distal RUJ - how + check (2)

A

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

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11
Q

WH: Radio - CT

bone density - pathology + 2 types + where usually found + signal in MRI

A

bone density
- osteonecrosis: scaphoid (preiser’s), lunate (kienbock)

for MRI it’s in proximal pole, low signal

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12
Q

WH: Radio - CT

cartilage/space - check (1), late what = (1), degenerative what is d/t what, for (3)

soft tissue - most common pathology

A

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

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13
Q

WH: Radio - MRI

further clarify (3)

use what - purpose, see what

A
  • further clarify: RA, infection, neoplasm

microscopy surface coil
- smallest = better resolution
- see small shit (TFCC)
- dec need for MRA

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14
Q

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

A

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

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15
Q

WH: Radio - MRI

soft tissue (ligaments) - extrinsic, intrinsic, volar, interroseous, which carpals has most ligament attachments, signal

A
  • 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
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16
Q

WH: Radio - MRI

soft tissue (tendon) - effect thing how + signal, tendon sheath what + if inflamed then what & signal

A

magic angle effect
- tendon 55 to magnetic field = intermediate signal

tendon sheaths
- specialized tubular bursa
- inflammation = fill circumferentially = high signal on T2

17
Q

WH: Radio - MRI

soft tissue (neural) - 3 nerves best veiw, signal

soft tissue (muscle) - signal

A

SOFT TISSUE ON NEURAL
- median radial ulnar: best in cross-sectional on axial
- intermediate signal

SOFT TISSUE ON MUSCLE
- intermediate signal

18
Q

WH: Conditions

when, for (3)

immob - position (2), stable unstable avulsion complete

A
  • 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

19
Q

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)

A

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

20
Q

WH: Conditions

hamate fx - MOI (2.1), extra structure affect + effect

radial head fx - name, structure (2)

ulnar styloid fx - structure/d/t

A

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

21
Q

WH: Conditions

scaphoid fx - MOI (1), common d/t (3), types (3) + vascularity + which most common

A
  • 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

22
Q

WH: Conditions

lunate distal radial head fx - name, MOI (1), seen when, stages (3.3.4.4)

A
  • 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

23
Q

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

A

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

24
Q

WH: Conditions

distal radial head fx - MOI (1), who (3), radial angle + indication/structures (4), colle’s smith barton galleazi what + portion

A
  • 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

25
Q

WH: Conditions - DRUJ Instability

joints (2), pathology, sx on what motion

PROSUP vs. UD

popping indication (3)

dorsal vs. volar instability

A
  • DRUJ & intercarpal joints
  • degenerative arthritis
  • pain on rotations: PRO SUP (DRUJ), UD (TFCC)
  • popping/snapping = TFCC, tendon, ligament
  • dorsal instability: pain & disloc on pronation
26
Q

WH: Conditions

CID - structure (2), types (3) + MOI of 2nd (2 pos)

CIND - structure (2), types + sx (2) +pathology

CIC - structures (2), type + pathology + stages (2G)

A

CARPAL INSTABILITY DISSOCIATIVE
- intrinsic ligaments, same row of carpals
- unstable scaphoid, scapholunate (fall on extended UD wrist), lunotriquetral

CARPAL INSTABILITY NON-DISSOCIATIVE
- extrinsic, entire proximal row
- triquetrum-hamate-lunate: pain & clicking when moving from UD to RD; sublux only during movement

CARPAL INSTABILITY COMBINED
- extrinsic + intrinsic

perilunate dislocation
- capitate away from lunate
- stage 1: dorsal dislocation (capitate volar), volar dislocation (capitate dorsal)
- stage 2: dorsal dislocation (lunate volar)

27
Q

WH: Conditions - TFCC

purpose (2), vascularization, d/t (2), what

imaging - signal (2G), best view, tears

A

TFCC
- compensate for ulna x wrist mismatch
- controls DRUJ/radioulna
- central 80-85% = avascular
- d/t: radial fx, loading on ulnar side of wrist
- biconcave fibrocartilage band

imaging
- low signal + surrounded by high signal synovial fluid or hyaline cartilage
- best view: coronal
- tears = perpendicular to long axis of TFCC

28
Q

WH: Conditions - CTS

what, trend, etiology (1.3.1.2)

imaging - SW use what, EMG, conventional, US, MRI

A
  • compression neuropathy of median nerve
  • epi: most common neuropathy of UE

etiology
- anatomic: fx
- inflammatory: alcohol, DM, thyroid
- mechanical: repetitive
- fluid shift: pregnancy, menopause

imaging
- semmes weinstein: use filament; find fingertips sensitive
- EMG-NCV: ddx other impingement
- conventional: ddx other osseous/fx
- US > MRI

29
Q

WH: Conditions

DJD - where (3), specific conditions (2)

basal joint arthritis - who (2), where, stages (1.2.1.1)

RA - where (4), laterality, pathology, imaging sx (2)

imaging sx (3)

A

DEGENERATIVE JOINT DISEASE
- PIP (heberden) DIP (bouchard)1st CMC

BASAL JOINT ARTHRITIS
- no trauma, or fx + has RA
- 1st CMC

stages
- stage 1: ligamentous laxity of 1st CMC
- stage 2: chronic laxity, OA
- stage 3: OA of adjacent joints
- stage 4: OA of thumb MCP

RA
- wrist, MCP, PIP, DIP
- systemic & (B)
- imaging: ulnar shift of scaphoid, ankylosing

IMAGING
- osteophytes at joint margin
- sclerosis at subchondral bone
- dec joint space

30
Q

WH: Advanced Imaging

arthro - structure (3), via, 1=1

bone scan - for (2), see (4)

US - see (2)

CT - see (3)

MR - see (4)

bone: CANA

A

ARTHROGRAPHY / 3 PHASE
- midcarpal, radiocarpal, radioulnar joints via separate injections
- leakage from RCJ to DRUJ = TFCC tear

BONE SCAN
- screening; localize problem not pathology
- cancer, avascular, nonunion, arthrosis

US
- intraosseous ganglion, synovial cyst

CT scan & CRa
- joint irregularity, localize contrast media leak, subtle fx

MRI & MRa
- vascular, intraarticular fx, TFCC, interosseous ligament

IMAGING (8 decks)

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