A day in the life of a radiologist Entry posted by Ian Wong August 8, 2014 2,285 views Share More sharing options... Followers 1 Random MSK finding. Let's see if this works. Anyone know what this is? Ian Report Entry
Ian Wong 111 Posted August 8, 2014 Report Share That's good for half credit! Ian Quote Link to comment
Depression 20 Posted August 8, 2014 Report Share I had to search it up and I'm still not sure what I'm looking for! Is it the scaphoid and pisiform? Quote Link to comment
Ian Wong 111 Posted August 9, 2014 Report Share There is a scaphoid and a pisiform, but they are normal. Not the significant finding. Quote Link to comment
Depression 20 Posted August 9, 2014 Report Share Another guess but there is no scapholunate space between the capitate and hamate. Quote Link to comment
LostLamb 326 Posted August 9, 2014 Report Share 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??? Quote Link to comment
Ian Wong 111 Posted August 11, 2014 Report Share Nope. 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. Ian LostLamb 1 Quote Link to comment
frozenarbitor 23 Posted August 14, 2014 Report Share Lunate looks slightly dorsally facing with capitate ventrally flexed. Dorsal intercalated segment instability (DISI)? Quote Link to comment
Ian Wong 111 Posted August 15, 2014 Report Share 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. http://radiopaedia.org/articles/kienbock-disease Ian Hoowin, nino and frozenarbitor 3 Quote Link to comment
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