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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. http://radiopaedia.org/articles/kienbock-disease Ian

Hi all, This radiologic sign is known as the "Double PCL sign." This is diagnostic of a bucket-handle tear of a meniscus, usually the medial meniscus, which is flipped into a position where it lies anterior to the PCL, and mimicks the appearance of a second PCL. In the above image, there is a curvilinear black structure originating from the distal femur, and then extending posteriorly and inferiorly to insert on the posterior aspect of the proximal tibia. This structure is the PCL. Just anterior to the PCL is a second, flatter, curvilinear structure interposed between the distal femur and proximal tibia. This is the torn meniscus. On this single image, it is impossible to tell which meniscus it is, but usually it is the medial meniscus, and it would be evident when you are shown the remaining MRI images. Here's the Radiopedia article for the "Double PCL sign." http://radiopaedia.org/articles/double-pcl-sign frozenarbitor and TheFancyPanda, The ACL is only seen on a few slices in the sagittal plane, and I haven't shown you any of those images. So unfortunately, on the single image provided, no comment can be made on the ACL. Similarly, the LCL complex is not included in the above image, and also therefore is of unknown status.

A few months late, but thank you very much for your post. At the moment, I'm working a job that isn't bringing me closer to becoming a doctor, but the thought is still there, looming. Your kind words mean a lot to this stranger on the other end of the keyboard. Hi Julia, Thank you, really, for your great post. I honestly did not expect anybody to read this, so it's a nice surprise. Ya know, I don't know if I've truly carved out the "why" yet. "To help people" is kind of a weak reason. Many professions help people, so what sets medicine apart? Rereading my journal entry is interesting, because my feelings and thoughts have changed even since then. Who knew we change so much over so little time? I will write another entry and address some of the things you brought up.

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