|
September 2008 Radiology Quiz
This patient is a 24 year old male who presents to the ED with the complaint of wrist pain after a fall. The following x ray is shown.
Questions:
1. Describe what you see?
- Lunate is rotated forward slightly on lateral view while all other carpal bones are dislocated posteriorly
- Diagnosis: Perilunate dislocation.
2.What would you find on physical exam?
- On physical examination there is dorsal wrist swelling and decreased wrist motion (especially flexion.)
- A palpable fullness may be noted on the dorsal side of the wrist after a dorsal perilunate dislocation and on the volar surface with a volar lunate dislocation.
- The median nerve may be compressed in the carpal canal by the lunate, and the patient may display signs of a median nerve injury.
3. What is the common cause for this injury?
- The most common mechanism is a fall on an outstretched, hyperextended hand.
4. What would be your management for this patient?
- Pain medication
- Immediate Hand Surgery consult
5. What motions occur at the acroioclavicular joint?
- Rotation of the acromion on the clavicle
- Minor gliding motion(accommodating for sternoclavicular movement)
Trivia: What is the significance of June 27, 2008 and Bruce Sprinsteen song, "4th of July, Asbury Park (Sandy)?
- A. Marie Castello, who had told fortunes since the 1930s and became famous for her presence and predictions on the Asbury Park boardwalk, died Friday June 27, 2008. The psychic reader and advisor was 93. She became known worldwide from Bruce Springsteen's homage to her in his music. "Did you hear the cops finally busted Madam Marie,'' Springsteen sang in his 1973 song, "4th of July, Asbury Park (Sandy)'' "for tellin' fortunes better than they do."
|
