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(3) Musculoskeletal Imaging > S2_L4 Anatomy & Radiologic Evaluation of the Wrist & Hand > Flashcards

S2_L4 Anatomy & Radiologic Evaluation of the Wrist & Hand Flashcards

1
Q

Modified TF
A. The hand and wrist are the most radiographed areas of the skeleton in any age group.
B. Immediate imaging is important to prevent long term disability and surgical intervention.

A

TT

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2
Q

Modified TF
A. In the wrist and hand, a high incidence of traumatic fractures and degenerative conditions occur from repetitive microtrauma or arthritic deformities.
B. The most common mechanism of injury is a fall on a hyperflexed hand.

A

TF

B. The most common mechanism of injury is a fall on an outstretched hand.

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3
Q

Modified TF
A. The most commonly dislocated carpal bone is the scaphoid.
B. The most commonly fractured carpal bone is the lunate.

A

FF

A: The most commonly dislocated carpal bone is the lunate.
B: The most commonly fractured carpal bone is the scaphoid.

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4
Q

TRUE OR FALSE: The ligaments of the wrist and hand are better visualized on musculoskeletal US and MRI.

A

True

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5
Q

Modified TF
A. In the normal radiographic appearance of the hand of an 18-month-old child, the ossified centers of the capitate and hamate are visible.
B. The secondary ossification centers of the proximal phalanges (MCPs) and distal radius can also be viewed.

A

TT

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6
Q

TRUE OR FALSE: Ultrasound is contraindicated for pediatric patients, to prevent frying of the epiphyseal plates.

A

True

NOTE: For children, you can decrease the intensity of the US.

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7
Q

Modified TF
A. At the stage of development of an 11-year-old child, all carpals are ossified, and the epiphyses of the ulna, radius, metacarpals, and phalanges are almost completely ossified.
B. The epiphyseal plates are still present, appearing as radiolucent lines parallel to the ends of the epiphyses.

A

TT

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8
Q

Modified TF
A. The wrist and hand have separate radiographic examinations.
B. The basic projections that are recommended for the wrist and hand are posteroanterior, lateral, and oblique views.

A

TT

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9
Q

Modified TF
A. If a singular digit is an area of interest, radiographic examination of that digit will be performed.
B. Ulnar and radial deviation are the two common projections for the wrist.

A

TT

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10
Q

Advanced Imaging Evaluation

  1. It is useful in evaluating wrist ganglia, tenosynovitis, & tendon rupture.
  2. Used for a global examination of both osseous and soft tissue structures.

A. Conventional radiograph
B. CT Scan
C. MRI
D. Ultrasound

A
  1. D
  2. C
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11
Q

Advanced Imaging Evaluation

  1. Used for follow-up of complex fractures and distal radioulnar subluxations.
  2. The first line of treatment for diagnosis; cost-effective
  3. Relatively cheaper than MRI

A. Conventional radiograph
B. CT Scan
C. MRI
D. Ultrasound

A
  1. B
  2. A
  3. B
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12
Q

Advanced Imaging Evaluation

  1. For diagnosis of CTS and measurement of thickness of TFCC
  2. For the detection of scapholunate and lunotriquetral tears in the event of a dislocation of the lunate bone

A. Conventional radiograph
B. CT Scan
C. MRI
D. Ultrasound

A
  1. D
  2. D
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13
Q

Advanced Imaging Evaluation

  1. Used to exclude an abnormality and may direct further imaging
  2. Useful in detecting occult fractures, ulnocarpal impaction, avascular necrosis, tears of the TFCC, and ligamental tears

A. Conventional radiograph
B. CT Scan
C. MRI
D. Ultrasound

A
  1. A
  2. C
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14
Q

Advanced Imaging Evaluation

Modified TF
A. CT Arthrography is the equivalent to MSK US in diagnosing TFCC tears.
B. MR Arthrography is primarily used for the evaluation of the TFCC, and scapulolunate, lunotriquetral, and peripheral tears of the TFCC.

A

FT

A: CT Arthrography is the equivalent to MRI in diagnosing TFCC tears.

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15
Q

Modified TF
A. Osteonecrosis of the scaphoid is referred to as Preiser’s disease.
B. Osteonecrosis of the lunate is referred to as Kienbock’s disease.

A

TT

NOTE: Negative ulnar variance can occur in Kienbock’s disease, where the usual space between the radius and ulna is absent due to the collapse of the lunate bone.

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16
Q

CT Scan Variations

TRUE OR FALSE: The Scaphoid Imaging Protocol is performed by placing the hand in radial deviation and aligning the long axis of the scaphoid to the gantry.

A

False, the Scaphoid Imaging Protocol is performed by placing the hand in ulnar deviation and aligning the long axis of the scaphoid to the gantry.

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17
Q

Modified TF: CT Scan Variations
A. For Distal Radioulnar Joint Stability,
it is performed by placing both forearms in the scanner and imaging the wrists while the forearms are in pronation.
B. DRUJ stability is assessed by a bilateral comparison of how the ulna articulates to the radial notch or if the ulna subluxes from the radial notch.

A

FT

A: For Distal Radioulnar Joint Stability,
it is performed by placing both forearms in the scanner and imaging the wrists while the forearms are in supination.

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18
Q

TRUE OR FALSE: Electronic devices are contraindicated for MRI of the wrist and hand.

A

True

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19
Q

Modified TF
A. In the basic MRI protocol, a local coil receiver is always used for the wrist and hand.
B. A large coil is preferred for better resolution.

A

TF

B: A smaller coil is preferred for better resolution.

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20
Q

Basic MRI protocol

Modified TF
A. Microscopy surface coils are the smallest kind of coils used.
B. These coils can provide excellent details of very small structures such as the TFCC, and have a decreased need for MR Arthrography.

A

TT

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21
Q

Routine Radiologic Evaluation of the Hand

Modified TF
A. The posteroanterior view best demonstrates the hand, wrist and distal forearm.
B. In the lateral view, the thumb is seen in a true PA projection.

A

TT

NOTE: The lateral view focuses on the thumb

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22
Q

Routine Radiologic Evaluation of the Hand

Modified TF
A. In the PA view, the structures best shown are the phalanges, metacarpals, carpals, and all joints of the hand.
B. The oblique view also demonstrates the phalanges, metacarpals, carpals, and all joints in the hand.

A

TT

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23
Q

Routine Radiologic Evaluation of the Hand

Modified TF
A. In the oblique view, a foam wedge may be used to keep the hand at 35º which prevents the foreshortening of the phalanges and obscuring of the interphalangeal joints.
B. Despite the superimposition in the lateral view, it can detect displacement of fracture segments easily.

A

FT

A: In the oblique view, a foam wedge may be used to keep the hand at 45º which prevents the foreshortening of the phalanges and obscuring of the interphalangeal joints.

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24
Q

Routine Radiologic Evaluation of the Hand

Modified TF
A. The metacarpal sign can be viewed in the PA view.
B. It is a line drawn along the distal articulating surfaces of the 5th to 2nd metacarpals.

A

TF

B: It is a line drawn along the distal articulating surfaces of the 5th to 3rd metacarpals.

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25
Q

Routine Radiologic Evaluation of the Hand

Modified TF
A. For the PA view, the patient’s palm and fingers are placed flat on the film cassette.
B. For this view, the central ray passes perpendicular to the hand at the 3rd MCP joint.

A

TT

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26
Q

Routine Radiologic Evaluation of the Hand

Modified TF
A. The foam wedge/block for the oblique view is used when the phalanges are a primary area of interest.
B. The elevation provided opens up the MCP and IP joint spaces.

A

TT

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27
Q

Routine Radiologic Evaluation of the Hand

Modified TF
A. For the lateral view, the ulnar side of the hand and wrist is placed on the image receptor and the central ray passes through the 2nd MCP joint.
B. Various sesamoid bones are demonstrated in this view.

A

TT

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28
Q

Routine Radiologic Evaluation of the Hand

Modified TF
A. In the PA view, there is an overlap of the trapezium and trapezoid, and the pisiform and the triquetrum.
B. The oblique view is more preferred than the lateral view.

A

TT

29
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. The PA view demonstrates the middle and proximal portions of the metacarpals, carpals, the distal radius and ulna, and all related joints.
B. The structures best shown on the oblique view are the trapezium, scaphoid, and the 1st CMC of the thumb.

A

TT

30
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. The lunate, triquetrum, hamate, and pisiform are best shown in the ulnar deviation PA view.
B. The scaphoid appears elongated for the ulnar deviation PA view because of the rotation of its distal pole towards the ulna.

A

FT

A: The lunate, triquetrum, hamate, and pisiform are best shown in the radial deviation PA view.

31
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. The ulnar deviation PA views the scaphoid and the adjacent opened radial intercarpal abscess.
B. This view can help identify subtle scaphoid fractures.

A

TT

32
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. In the radial deviation PA view, the scaphoid is well demonstrated and almost unobstructed.
B. In the ulnar deviation PA view, the scaphoid is more superimposed to make way for the radial styloid.

A

FF

A: In the ulnar deviation PA view, the scaphoid is well demonstrated and almost unobstructed.
B. In the radial deviation PA view, the scaphoid is more superimposed to make way for the radial styloid.

33
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. In the radial deviation PA view, the scaphoid is shortened in this view since the distal pole is rotated toward the palm to clear the radial styloid.
B. The fractures of the hook of the hamate are seen better in the carpal tunnel view.

A

TT

NOTE: Fractures of the hook of the hamate impinge on the ulnar nerve

34
Q

Optional Wrist View

Modified TF
A. The carpal tunnel view is an inferosuperior view of the wrist that allows for visualization of the carpal sulcus.
B. In this projection, the central ray passes perpendicular through the carpal tunnel.

A

TF

B: In this projection, the central ray passes tangentially through the carpal tunnel.

35
Q

Optional Wrist View

Modified TF
A. The carpal tunnel view is done to identify abnormalities of the bones or soft tissues that may be compressing the median nerve and extensor tendons.
B. Any bones that are misaligned from position may contribute to CTS.

A

FT

A: The carpal tunnel view is done to identify abnormalities of the bones or soft tissues that may be compressing the median nerve and flexor tendons.

36
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. The three arcuate lines on PA view are from proximal to distal, to check for the usual alignment of the carpal bones.
B. The PA view also shows the radial angle, which normally ranges from 10-15º.

A

TT

NOTE: Decreased or absent radial angle / inclination & radial length usually indicates radial fracture

37
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. The central ray passes through the midcarpal joint for both PA and lateral views.
B. Displaced fracture segments are easily viewed in the lateral view.

A

TT

38
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. Certain aspects of the carpals (hamate, triquetrum, and trapezium) are well demonstrated in the oblique view.
B. The hook of the hamate is visualized, but the body is superimposed in this view.

A

TF

B: The body of the hamate is visualized, but the hook is superimposed in this view.

39
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. In the oblique view, the dorsal aspect of the triquetrum is visualized.
B. In this view, the trapezium and its articulations to the trapezoid, scaphoid, and 1st metacarpal are well visualized.

A

TT

40
Q

Routine Radiologic Evaluation of the Wrist

Lateral View:
1. Scapholunate angle values vary between [] to []º
2. Capitolunate angle should be less than []º

A
  1. 30 to 60
  2. 20

NOTE: Altered values of capitolunate angle indicate disruption of the lunate’s location

41
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. Alignment of the longitudinal axes of the radius, lunate, capitate, and 3rd metacarpal bones are best demonstrated in the lateral view.
B. On oblique projection, the palm is facing the image receptor with the wrist rotated 45º from the PA position.

A

TT

42
Q

Routine Radiologic Evaluation of the Wrist

TRUE OR FALSE: Volar tilt, or palmar inclination, is measured as the angle determined by the intersection of a line perpendicular to the midshaft of the radius and a line drawn across the distal radial articular surface.

A

True

43
Q

Routine Radiologic Evaluation of the Wrist

Modified TF
A. The lateral view demonstrates the superimposed proximal metacarpals, carpals, distal radius, and ulna as seen laterally.
B. The oblique projection demonstrates the middle and proximal metacarpals, the carpals, and the distal radius and ulna in an oblique view.

A

TT

44
Q

Modified TF
A. On MRI of soft tissues, thenar and hypothenar muscles can be viewed.
B. These muscles have low signal intensity on all sequences.

A

TF

B: These muscles have intermediate signal intensity on all sequences.

45
Q

Modified TF
A. On MRI, the median, ulnar, and radial nerves are best seen in cross section on the axial plane.
B. Neural signal is usually intermediate and is hypointense to muscle on all sequences.

A

TF

B: Neural signal is usually intermediate and is isointense to muscle on all sequences.

46
Q

Modified TF
A. Deep and superficial flexor tendons cross the wrist on the dorsal side.
B. Deep and superficial extensor tendons cross the wrist on the palmar side.

A

FF

A: Deep and superficial flexor tendons cross the wrist on the palmar side.
B: Deep and superficial extensor tendons cross the wrist on the dorsal side.

47
Q

Modified TF
A. Extrinsic ligaments of the wrist and hand connect the radius and ulna to the carpals, and the carpals to the metacarpals.
B. Intrinsic ligaments, on the other hand, connect individual carpals to each other.

A

TT

48
Q

TRUE OR FALSE: On MRI, the magic angle effect may occur in tendons oriented 45º to the main magnetic field and show intermediate signal intensity.

A

False, on MRI, the magic angle effect may occur in tendons oriented 55º to the main magnetic field and show intermediate signal intensity.

49
Q

Modified TF
A. Tendons sheaths are specialized tubular bursae with a potential space that contains blood vessels and a small amount of fluid.
B. This fluid fills circumferentially if inflamed and show high signal intensity on T2 weighted images on the MRI.

A

TT

50
Q

Modified TF
A. Volar ligaments are key stabilizers of the wrist.
B. The scaphoid and lunate have the most ligamentous attachments of the carpals.

A

TF

B: The capitate and lunate have the most ligamentous attachments of the carpals.

51
Q

Modified TF
A. In MRI, TFCC imaging is best on the coronal plane.
B. Low bone signals on both T1 and T2 indicate necrosis.

A

TT

52
Q

Modified TF
A. MRI can be used to provide a second look for occult fractures and check for associated bony injury that occurred during trauma.
B. Scapholunate dissociation is a common malalignment due to ligamentus tearing.

A

TT

53
Q

Modified TF
A. MRI can be used to check the bone signals of the proximal pole of the scaphoid and the lunate, which are the most common areas for osteonecrosis.
B. Bone bruises or marrow edema, stress fractures, osteochondral injuries, or radiologically ambiguous fractures can also be detected.

A

TT

54
Q

Modified TF
A. Ulnolunate impaction is due to the chronic abutment of the distal ulna to the lunate.
B. This impaction results in degenerative changes in the cartilage and bone, which can be seen on MRI.

A

TT

55
Q

Modified TF
A. On CT scan, the most common soft tissue abnormalities are the ganglion cysts at the dorsum of the wrists.
B. These cysts may be seen attached to the joint capsule, tendon sheath, or ligament; they are most commonly attached to the tendon sheath.

A

TT

56
Q

CT Scan

Modified TF
A. The alignment of the radius to the carpals is noted on sagittal slices.
B. The ulnar variance and the three arcuate lines of the carpal rows are noted on coronal slices.

A

TT

57
Q

3 arcuate lines on PA view

  1. Outlines the distal concave surfaces of the scaphoid, lunate, and triquetrum
  2. Outlines the proximal convex margins of the capitate and hamate
  3. Outlines the proximal convex surfaces of the scaphoid, lunate, and triquetrum

A. Arc I
B. Arc II
C. Arc III

A
  1. B
  2. C
  3. A
58
Q

Modified TF
A. On MRI, fat suppressions are used to highlight the cartilage.
B. All adjacent carpals have interosseous ligaments, and ligaments are seen as high signal intensity on all MRI sequences.

A

TF

B: All adjacent carpals have interosseous ligaments, and ligaments are seen as low signal intensity on all MRI sequences.

59
Q

TRUE OR FALSE: T1 fat-suppressed sequence is used post injection to make it easier to define tears and defects on MRI.

A

True

60
Q

Modified TF
A. CT Scan of the wrist extends from the distal radial and ulnar metaphyses to the metacarpal bases.
B. Radioulnar articulation, arrangement of the carpals, and the configuration of the carpal tunnel and ulnar tunnel are noted on axial slices.

A

TT

61
Q

TRUE OR FALSE: CT scan is indicated for cases of severe trauma and the assessment of displacement of distal radial fractures or carpal fractures.

A

True

62
Q

Volar tilt (palmar inclination / palmar tilt of the radius) of the radial articular surface normally ranges from [] to []º and helps in assessing radial fracture displacement.

A

16 to 25

63
Q

The ff are specific scenarios for MRI evaluation, except:

A. Acute or chronic wrist instability
B. Dorsal or ulnar sided wrist pain
C. Wrist symptoms in adolescent gymnasts
D. Unexplained swelling, mass, or atrophy
E. None

A

E. None

64
Q

The ff are specific scenarios for MRI evaluation, except:

A. Present with symptoms after wrist surgery
B. Unexplained chronic wrist pain
C. Wrist malalignment
D. Acute wrist trauma
E. None

A

E. None

65
Q

Modified TF
A. CT scan can be used to assess cartilage damaged by trauma, and may be associated with articular fractures.
B. Damage may also be due to a late effect of fracture healing that resulted in the alteration of joint alignment.

A

TT

66
Q

TRUE OR FALSE: Degenerative lesions can occur as a result of excessive strain over articular surfaces caused by posttraumatic instability or malalignment.

A

True

67
Q

The ff are indications for MRI of the wrist and hand, except:

A. Ulnocarpal impaction syndrome
B. Osteonecrosis
C. Ganglion cysts
D. Guyon’s canal syndrome, hematomas, nerve sheath tumors
E. None

A

E. None

68
Q

The ff are indications for MRI of the wrist and hand, except:

A. Flexor and extensor tendon disorders
B. Primary, secondary, and recurrent carpal tunnel syndrome
C. Scaphoid fracture complications
D. Dorsal and volar extrinsic ligament abnormalities
E. None

A

E. None

69
Q

The ff are indications for MRI of the wrist and hand, except:

A. TFCC abnormalities
B. Scapholunate and lunotriquetral interosseous ligament abnormalities
C. To further clarify RA, and neoplasm or infection of bone, joint, or soft tissue
D. Distal radius, scaphoid, and other carpal bone fractures with equivocal radiographs
E. None

A

E. None

(3) Musculoskeletal Imaging (25 decks)

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