The Lunate That Died

​Everyone who works with me knows that I love joint radiographs, and the wrist is my favorite. It was no surprise when I came on shift that someone exclaimed, "I have an x-ray for you. I bet you will know exactly what it is! This 30-ish-year-old lady came in with atraumatic wrist pain."I did know exactly what it was. My eyes were drawn to the lucent lunate target. The patient was still in the ED, so I went to examine her hand. She had increased pain when I walked my fingers proximally down the metacarpal, which dipped into the carpal space. She was also not a fan of volar flexion or dorsiflexion. It made sense. The lunate lives just proximal to the base of the third ray. The lunate pops up in that space when one bends the wrist down.The lunate was not living there in this case. It had died there. She had Kienbock's disease, an avascular necrosis of the lunate. Kienbock's disease can be associated with trauma, skeletal variations, and systemic diseases like sickle cell anemia and lupus. If this were traumatic, the injury happened months or years ago. Looking at Gilula's arcs, it was easy to see the capitate overriding the disintegrated lunate. There was no discernible sclerotic joint space line at the distal lunate. One should always see a small gap between the sclerotic surfaces of the joints. This patient needed surgical intervention, perhaps a fusion, lunate implant, or proximal row carpectomy.Tip to Remember: Always check Gilula's arcs when reviewing wrist...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

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Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
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Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
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Source: Revista Espanola de Medicina Nuclear e Imagen Molecular - Category: Nuclear Medicine Source Type: research
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Source: NeuroImage - Category: Neuroscience Source Type: research
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Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Arch Acad Emerg Med Source Type: research
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Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Arch Acad Emerg Med Source Type: research
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Source: Korean Journal of Anesthesiology - Category: Anesthesiology Tags: Korean J Anesthesiol Source Type: research
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Source: The Medical Futurist - Category: Information Technology Authors: Tags: Genomics 23andme ancestry DNA DTC future genetic test Genetic testing genetics Genome genome sequencing Health 2.0 Source Type: blogs
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