Back and Limbs Case 2
This is an image of a 30 year old with severe wrist pain after an assault, in which they were hit in the wrist with a baseball bat.
Question 1:
What are technical parameters for this image?
This is an AP view of the wrist.
The labels below show you all of the wrist bones, and one bone that is abnormal.
Back and Limbs Case 2
This image set shows you a comparison from a person with a normal wrist.
Question 2:
What are technical parameters for the comparison study?
This is a normal wrist arthrogram. That is a procedure where contrast material (containing iodine, which makes it appear dense or white on x-ray imaging) has been injected into a joint space, in this case the proximal part of the wrist joint.
Back and Limbs Case 2
This is an additional image of the same patient, with a normal comparison study.
Question 3:
What are technical parameters for these images?
These are both oblique views of the wrist. Because the wrist is so complex in shape, we often do additional imaging besides just AP and lateral views. Different joints of the wrist are seen best in various different x-ray images depending on the angle of the beam.
Try to identify for yourselves the structures indicated on the labels before bringing up the annotated images.
Back and Limbs Case 2
This is another view of our patient's wrist, along with a normal comparison.
Question 4:
What are technical parameters for these images?
These are both lateral views of the wrist. This case points out the importance of looking at multiple views when a patient has significant symptoms. The AP and oblique views showed only a fairly subtle abnormal contour and fracture of the radial styloid process. The lateral view is the only one that confirms a complete dislocation of the radio-carpal joint! Because the dislocation went straight back, it was not evident on the other views.
This patient has an incidental finding of a very common normal variant--an extra sesamoid bone. See if you can find it before checking the label. This is the commonest site in the hand for an extra sesamoid bone.
