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E1132. Oh Carp! Radiographic and MRI Evaluation of Subtle Carpal Pathologies
Authors
  1. Frank Chen; Atlantic Health Systems
  2. Nirmaan Dayal; Atlantic Health Systems
  3. Michelle McBride; Atlantic Health Systems
  4. Lawrence Wang; Atlantic Health Systems
  5. Paul Schulze; Atlantic Health Systems
  6. Sean Mendonca; Atlantic Health Systems
Background
As emergency imaging volumes increase during call, radiologists and radiology residents often prioritize focusing on cross-sectional imaging modalities over radiographs. As such, radiographs are often treated as an afterthought. When reading through large number of cases in a time constraint, subtle pathologies in small joints such as hands and wrists may be overlooked or missed by less seasoned radiology residents. Attention to details in hands and wrists radiographs is vitally important for radiologists to recognize as small pathologies may alter the course of patient’s treatment plan dramatically. For example, subtle carpal fractures may be the difference between surgical treatment and conservative management. Delay recognition may sometimes even render the pathology non-operative and result in lasting negative consequence to the patient’s quality of life. The purpose for this presentation is to educate radiologists further in recognizing these pathologies more comfortably, ensuring proper and safer patient care.

Educational Goals / Teaching Points
1) Demonstrate relevant normal radiographic anatomy of the wrist on various projections with appropriate search patterns. 2) Illustrate clinically important, subtle and often missed carpal pathologies on wrist radiographs that may be helpful for radiologists. 3) Demonstrate MRI correlates for each pathology. Identify pitfalls in anatomic variants which radiologists should watch out for. 4) Provide the clinical aspects of each type of pathologies, such as mechanism of action, clinical presentation, and clinical consequences as they relate to orthopedic management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Topics for discussion and review of original images for each specific topic include: *Clinical presentation and relevant information. *Mechanisms of action of the Injury. *MR and radiographic imaging findings and pitfalls. *Treatment options from orthopedic standpoint. Specific topics with original images include: 1) Subtle carpal bone fractures. 2) Lunate Dislocation. 3) Preilunate Dislocation. 4) Volar intercalated segmental instability (VISI). 5) Dorsal intercalated segmental instability (DISI). 6) Scapholunate advanced collapse (SLAC). 7) Scaphoid nonunion advanced collapse (SNAC). 8) Kienbock’s disease. 9) Ulnar impaction syndrome.

Conclusion
We aim to educate radiologists and clinicians in recognizing various subtle carpal bone pathologies on radiographs as it pertains to clinical presentation and management options. As volume for imaging increase over time, it is imperative for radiologists to be vigilant in recognizing these pathologies and to determine when further correlation with MRI is indicated. It is a necessary aspect of the radiologist's role as consultant to communicate these findings in the most clinically relevant way to ensure effective proper intervention as needed.