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Normal Variants of the Normal Variants of the ElbowElbow
Olecranon Olecranon ForamenForamen
aka aka Supratrochlear Supratrochlear
ForamenForamen
Olecranon Olecranon ForamenForamen
Radioulnar SynostosisRadioulnar Synostosis
• usually bilateral• may decrease supination or
pronation
Supracondylar ProcessSupracondylar Process
• An osseous projection on the anteromedial aspect of the distal humerus
• Struther’s ligamentStruther’s ligament may extend inferior from this process to the medial epicondyle
• may cause neurovascular signs or symptoms
Fracture of Supracondylar ProcessFracture of Supracondylar Process
Ununited Ununited Secondary Secondary OssificatioOssification Center - n Center -
Medial Medial EpicondyleEpicondyle
Pseudotumor Pseudotumor appearance of appearance of
the Radial the Radial TuberosityTuberosity
The WristThe Wrist
Standard Wrist SeriesStandard Wrist Series
• PA Wrist
• Medial Oblique Wrist
• Lateral Wrist
PA PA Wrist Wrist
Note the overlap between the trapezium and the trapezoid
PA WristPA Wrist
Medial Medial Oblique Oblique
WristWrist
• No overlap between the trapezium and the trapezoid
Lateral WristLateral Wrist
Lateral WristLateral Wrist
-the third metacarpal, capitate, lunate and radius should form a straight line
Age of Carpal Appearance
• Capitate and Hamate: at birth-6 mo
• Triquetrum: .5 yr-3.5yrs
• Lunate: 1.5-4.5yrs
• Scaphoid: 3-9yrs
• Trapezium: 3-9yrs
• Trapezoid: 3-9yrs
• Pisiform 7-13yrs
• Distal radial epiphysis: .5-2yrs (19)
• Distal ulnar epiphysis: 5.5-9.5yrs(18)
Pronator Quadratus Fat Pronator Quadratus Fat StripeStripe
• Not visualized or may be displaced following trauma
Accessory Views of the Accessory Views of the WristWrist
PA Wrist with Ulnar PA Wrist with Ulnar DeviationDeviation
Carpal Carpal Tunnel Tunnel
ProjectionProjection
Three Arcs of Carpal Three Arcs of Carpal AlignmentAlignment
• Along proximal aspect of proximal row
• Along distal aspect of proximal row
• Along proximal aspect of distal row
Intercarpal DistancesIntercarpal Distances
• The joint spaces between the carpal bones should not exceed 2mm2mm
• the distal radioulnar joint space should not exceed 2mm2mm
Normal VariantsNormal Variants
Carpal CoalitionCarpal Coalition
• Fusion between the capitate and hamate possibly involving the triquetrum and pisiform
Carpal CoalitionCarpal Coalition
Accessory Ossicle Distal to Accessory Ossicle Distal to UlnaUlna
• Ununited secondary ossification center of the ulnar styloid process. Most likely represents old un-united fracture.
Pie SignPie Sign
Negative Ulnar VarianceNegative Ulnar Variance
• Normally the ulna should be no more than 1-2mm 1-2mm shorter shorter than the radius
• predisposes lunate to avascular necrosis
Madelung’s DeformityMadelung’s Deformity
• Delayed growth of medial distal radius
• may result in a posterior subluxation of the ulna and the “bayonette” appearance.
• Carpal angle >117°.
Madelung’s DeformityMadelung’s Deformity
Thank YouThank You