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Wrist XRay
Aka: Wrist XRay, Wrist Imaging, Radial Inclination, Radial Height, Volar Tilt
- Imaging: Views
- Standard
- Posterior-anterior XRay
- Lateral XRay
- Check alignment: Radius, Lunate/Scaphoid, Capitate
- Special
- Scaphoid Fracture suspected
- Scaphoid View
- Pisiform Fracture or hook of hamate Fracture suspected
- Carpal Tunnel view
- Supinated oblique view
- Scapholunate Dissociation
- Clenched-fist view
- Supinated wrist with ulnar deviation
- Imaging: Other imaging modalities
- Wrist Ultrasound
- Evaluates soft tissue (tendon, synovium)
- Variable efficacy based on operator
- Bone scan
- Finds occult Fractures (Scaphoid), Stress Fractures
- Highly sensitive but not specific for Fracture
- Wrist CT Scan
- Identifies Fractures and articular subluxations
- Wrist MRI
- Identifies Fractures and soft tissue injuries
- Expensive, but most sensitive and specific study
- Evaluation: Interpretation
- Post-Reduction Wrist XRay confirms normal radius length
- AP View
- Landmarks on AP View at distal radius
- Distal line
- Draw a horizontal line at the level of the radial styloid at the distal radius (point A)
- Represents the distal most point of the radial articular surface
- Proximal line
- Draw a horizontal line at the level of the ulnar aspect of the distal radius (point B)
- Represents the distal most point of the ulnar articular surface
- Articular plane
- Draw a line between the points A and B above (between ulnar aspect of radius and ulnar styloid)
- Normal anatomic relationships
- Radial styloid is distal to ulnar styloid
- Radial Inclination: 23.6 +/- 2.5 degrees
- Angle formed between the articular plane and the proximal line (see above)
- Radial Height:
- Distance between the proximal and distal lines (see above)
- Lateral View
- Landmarks on Lateral View at distal radius
- Distal dorsal rim
- Point on the distal radius at the dorsal aspect
- Distal volar rim
- Point on the distal radius at the volar aspect
- Vertical line at distal radius
- Perpendicular to the long axis of the radius
- Volar Tilt Line
- Line drawn between distal dorsal rim and distal volar rim
- Normal anatomic relationships
- Volar Tilt angle: 11.2 +/- 4.6 degrees
- Angle formed between Volar Tilt line and vertical line at distal radius
- Radius articular surface directed down, forward, in
- Appearance of tea cup and saucer
- References
- Medoff (2005) Hand Clin 21(3): 279-88 [PubMed]