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something looks off to me about trapezium/trapezoid...but this is coming from a psych resident with meagre MSK skills at best. 

Any history to add???

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Scapholunate space refers to the joint space between the scaphoid and lunate, and therefore not the capitate/hamate.  It is widened in scapholunate ligament disruption, which can lead to a SLAC (scapholunate advanced collapse) wrist deformity.


Trapezium/trapezoid is often difficult to see well on radiographs just related to their shape and the beam projection on standard radiographs, but there's nothing overtly abnormal about them either.



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I think the lunate-capitate alignment is ok.


This is a case of Kienbock's disease, which is avascular necrosis of the lunate.  Initially, radiographs are negative.  Later, the bone becomes sclerotic on radiographs, which is why it appears asymmetrically denser compared to the remaining carpal bones.  Eventually, you get collapse of the lunate, which leads to advanced secondary osteoarthritis.


It is associated with negative ulnar variance, where the distal radial epiphysis protrudes distal to the distal ulnar epiphysis.  One hypothesis, not proven, is that with negative ulnar variance, all of the forces transmitted from the forearm to the wrist go through the radio-carpal joint (with little support from the ulna).  This increases the stress placed on the lunate (which articulates with the radius), and results in avascular necrosis.





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