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1、HeerenMakanji,2011GillianLieberman,MDAugust2011HeerenMakanji,HarvardMedicalSchoolYearIIIGillianLieberman,MDHeerenMakanji,2011GillianLieberman,MDOurPatient#1:HistoryandPhysicalExam•36yowithFOOSH3monthsago•Persistentpaininradialsideofleftwrist,worsewithmovementhttp://www.picturesof.net/pages/
2、110102-144849-942053.html•AnatomicsnuffboxtendernessHeerenMakanji,2011GillianLieberman,MDOurPatient#1:DifferentialDiagnosis•Fracture(scaphoid,triquetrum,lunate,distalradius)•LigamentorTendonInjury•Dislocation•Osteoarthritis•Infection•NerveimpingementHeerenMakanji,2011GillianLieberman,MDOurP
3、atient#1:PlainFilmsPAViewObliqueViewPACS,BIDMCPACS,BIDMCFindings:LinearlucencyinscaphoidwaistwithsurroundingsclerosisHeerenMakanji,2011GillianLieberman,MDOurPatient#1:MRIT2-weightedMRIFindings:•Fracturelinethroughscaphoidwaist•Bonemarrowedema•CysticareasintheCONSIDER:WASTHISMRIINDICATED?bon
4、esPACS,BIDMCHeerenMakanji,2011GillianLieberman,MDOurPatient#2:HistoryandPhysicalExam•27yo,fellshorizontallyonrightwristandforearmFOOSH•Persistentpaininradialside,swellinghttp://singlemindedwomen.com/blog/sex-the-single-•Anatomicsnuffboxwoman-falling-for-you/attachment/tripping/tendernessHee
5、renMakanji,2011GillianLieberman,MDOurPatient#2:PlainFilmsPAViewScaphoidViewPACS,BIDMCPACS,BIDMCFindings:Softtissue/boneartifact,noevidenceoffractureHeerenMakanji,2011GillianLieberman,MDOurPatient#2:IntervalHistory•Wristimmobilizationwithcast•Scheduledforrepeatradiographs2weekslater•Painpers
6、isted,stillworsewithmovement•ContinuedanatomicsnuffboxtendernessHeerenMakanji,2011GillianLieberman,MDOurPatient#2:PlainFilms,1MonthLaterObliqueViewFindings:•LinearlucencyreflectingscaphoidfractureorsofttissuedensityPACS,BIDMCHeerenMakanji,2011GillianLieberman,MDOurPatient#2:MRIT2-weightedMR
7、IFindings:•Fracturelinethroughscaphoidwaist/distalpoleboundary•BonemarrowedemaindistalpoleCONSIDER:WASTHISMRIINDICATED?PACS,BIDMCHeerenMakanji,2011GillianLieberman,MDObjectives•RegionalAnatomyoftheWrist•MenuofRadiologicalTests•WhentoOrderCertainRadiologi
