Radiographic Evaluation of the Wrist: A Vanishing Art

Ulnar-sided wrist pain. II. Clinical imaging and treatment

“…For detecting perforations of the TFCC, one of the several causes of ulnar-sided wrist pain, triple-injection arthrography had been considered the “gold” standard [2, 3]. However, several authors have reported that arthrography of the wrist is much less accurate than arthroscopy and has a relatively high rate of false-negative findings [3, 4]. Therefore, during the past several years, arthrography has been largely supplanted by MR imaging for evaluating lesions associated with TFCC.…”

“…Plain radiography is not useful in characterizing TFCC abnormalities. However, radiographic findings associated with abnormalities of the complex, such as positive ulnar variance, the presence of an ulnar styloid fracture associated with peripheral avulsion of the TFCC, and avulsion fracture of the fovea of the ulna, that indicate injury at the site of attachment of the proximal lamina of the TFCC, may be encountered [3]. The neutral PA is the best view to measure ulnar variance.…”

Review of supplemental views and stress radiography in musculoskeletal trauma: upper extremity

“…There is a small intra-articular fracture (arrow) at the trapezium-second metacarpal articulation. This was occult on the standard hand radiograph series and later confirmed with CT Contralateral comparison is especially important in the skeletally immature patient due to presence of unossified cartilage resulting in apparent widening [11,14]. The ulnar deviation view elongates the scaphoid, allowing for evaluation of subtle waist fractures (Fig.…”

“…Though most commonly seen with fall on an outstretched hand, these injuries are also uniquely associated with sports injuries involving swinging a grasped object (e.g., baseball bat, racket, golf club). Delayed diagnoses may result in complications including carpal tunnel syndrome, osteonecrosis, nonunion, median or ulnar nerve palsies, and ulnar artery compromise [11,12]. The carpal tunnel view profiles the volar surfaces of the carpus and permits visualization of the pisiform and hook of the hamate without superimposition (Fig.…”

“…Split fractures of the trapezial body can lead to lateral subluxation of the first metacarpal. Fractures of the trapezial ridge, to which the carpal tunnel ligament attaches, are predisposed to nonunion and can lead to median nerve palsy [11]. The Bett's view orients all four articulations of the trapezium, profiling the scaphotrapezio-trapezoid and trapeziometacarpal joints (Fig.…”