IMAGING OF THE HAND AND WRIST
Section snippets
RADIOGRAPHY
All diagnostic imaging of the hand or wrist should begin with radiographs or plain films. However, a common mistake is to request the wrong or insufficient views. It is one of the basic concepts of radiology that at least two projections are required to evaluate any structure. Figure 1 is an example of why this is important. The authors' standard series of the hand or finger includes three views: postero–anterior (PA), oblique, and lateral. For the wrist, PA, PA ulnar deviation, oblique, and
STANDARD MEASUREMENTS
Given a well–positioned PA and lateral view of the wrist as described previously, it is possible to make many standard measurements of carpal height and alignment. These are described in detail in a review article by Mann and colleagues24 as well as in the textbook by Gilula and Yin.4 For many of these measurements, various clinicians advocate different methods of drawing the necessary lines. The following section details a few of the measurement schemes that the authors have found useful. The
CARPAL INSTABILITY
Numerous patterns of carpal instability have been described, and various schemes exist for classifying them. Carpal instabilities can be either static or dynamic. Static instabilities are manifest by abnormal alignment on PA and lateral radiographs obtained in neutral orientations, whereas dynamic instabilities can appear normal on neutral films and may require stress radiographs or provocative maneuvers to be revealed. The key to identifying carpal malalignment is to examine the position of
ADVANCED IMAGING MODALITIES
Planar radiographs coupled with physical examination are usually sufficient for the work–up of a painful hand or wrist. However, when these techniques fail to elucidate the cause of the symptoms, further imaging studies may be required. The following sections present representative cases illustrating the utility of these modalities. Readers seeking a more thorough discussion are referred to the specific modality chapters in the text by Gilula and Yin, as well as to a good review article on
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Address reprint requests to Ken L. Schreibman, PhD, MD, Department of Radiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216