Wrist and Hand Imaging

Question 1

Primary ossification center of MC and phalangeal shafts begins at

Answer 1

8 wks gestation

Shafts are fully formed at birth

Question 2

No ossification in carpals seen when

Answer 2

Newborn - 5 or 6 months

Question 3

Ossification centers of capitate and hamate appear at

Answer 3

6 months

Question 4

MCs and radius have secondary ossification centers by

Answer 4

1 year

Question 5

Triquetrum center ossification is visible by when

Answer 5

2 years

Question 6

Secondary ossificiation centers of ulna appear when

Answer 6

by 5 years

Question 7

All carpal bones except pisiforma are visible on xray when

Answer 7

by 6 years

Question 8

9-13 years - the secondary ossification centers of the phalanges are

Answer 8

Wider than the shafts

Capral bones are in their adult shapes

Question 9

All seondary ossification centers should be present at

Answer 9

14 years F

16 years M

Question 10

Routine projections

Answer 10

PA
Lateral
Oblique - often added to complete the series

Question 11

PA projection - position

Answer 11

hand as flat as possible with palmar aspect closest to the film
Thumb in oblique position

Question 12

PA projection - what is the longest

Answer 12

Proximal phalanges

Question 13

What is in line with the long axis of the radius

Answer 13

Long axis of the 2nd MC

Question 14

Where should you be able to draw a ling

Answer 14

Along distal articulating surfaces of the 3-5 MCs

Question 15

MC fx - common where

Answer 15

3rd and 4th - known as a boxers or brawlers fracture

Question 16

Thumb - sesamoid bones

Answer 16

2 of them at the MC head

Question 17

What inserts onto the sesamoid bones

Answer 17

Adductor pollicis - the ulnar one

Flexor pollicis brevis - radial one

Question 18

Sesamoid bones lie within the

Answer 18

palmar plate

close to origin of the tunnel for FPB

Question 19

What can cause fx to sesamoid bones

Answer 19

Severe hyperextension trauma - is probably more likely to rupture palmar plate and associated ligaments
Can develop hematoma through FPB

Question 20

Most commonly fractured carpal bone

Answer 20

Scaphoid

Question 21

Scaphoid is usually fractured where

Answer 21

at midpoint

Question 22

Kienbocks disease

Answer 22

Avascular necrosis of lunate - often without history of trauma

Question 23

Sesamoid within the flexor carpi ulnaris

Answer 23

Pisiform

overlaps triquetrum on PA

Question 24

Trapezium is superimposed with

Answer 24

Trapezoid

Question 25

Injury to trapezium

Answer 25

Rare - almost always collateral to injury of other wrist structures

Question 26

Capitate isolated injury

Answer 26

Rare

Question 27

Hamate fracture

Answer 27

Uncommon but should be considered if pt is involved in activities with clubs or bats

Question 28

Fracture of distal radius ___% of all skeletal fx

Answer 28

16%

Question 29

Alignment - carpal arches

Answer 29

Gilulas lines

Question 30

1st line - carpal arches - formed by

Answer 30

Proximal convex surfaces of scaphoid, lunate, and triquetrum

Question 31

2nd line - carpal arches - formed by

Answer 31

Distal concave surfaces of the same bones

Question 32

3rd line - carpal arches - formed by

Answer 32

proximal convex curves of capitate and hamate

Question 33

Ulnar variance

Answer 33

Difference between the length of ulna and radius | Should be less than or equal to 1.0 mm

Question 34

Positive ulnar variance - defined as ulna being

Answer 34

more than 1 mm distal to the radius

Question 35

Positive ulnar variance occurs with

Answer 35

age, secondary to degenerative changes in fibrocartilaginous disc

Question 36

Positive ulnar variance is associated with

Answer 36

ulnar impact fracture and lunotriquetral ligament disruption

Question 37

Positive ulnar variance is commonly seen in

Answer 37

gymnasts secondary to stress on radial growth plates

Question 38

Negative ulnar variance - define

Answer 38

ulna is shortened compared to the radius

Question 39

Negative ulnar variance - commonly seen in

Answer 39

Kienbocks disease

Question 40

Kienbocks disease

Answer 40

Osteonecrosis of the lunate

Question 41

Lateral view - best for determining what

Answer 41

displacements of long bones in hand and carpals

Question 42

Lateral view - what is resting on the receptor

Answer 42

Ulnar border of hand

Question 43

Lateral view - central ray moves from

Answer 43

Radial to ulnar

Question 44

Lateral view - what is magnified and why

Answer 44

Thumb - because of distance from the receptor

Question 45

Lateral view shows what view of thumb and what view of other fingers

Answer 45

Posterolateral of thumb | Lateral of rest of hand and wrist

Question 46

Lateral view - most bones are

Answer 46

superimposed | but can still identify displacement

Question 47

Volar tilt - angle formed between

Answer 47

A line connecting distal points of the volar and dorsal rim of the radius A second line perpendicular to the long axis of the radius