February 2022: Knowing Normal from Abnormal At a Glance

​One must know what normal looks like to recognize abnormal.I believe it was more difficult decades ago when I went through residency. The hard films were placed on an x-ray Rolodex that essentially forced us to look at many more images as they went rolling by until we stopped at the film we wanted. I had an hour of x-ray lecture every week during training. The spaced repetition and low-stakes quizzing imprinted the difference between normal and abnormal at a glance.​This is abnormal! Something is seriously out of place. If one knew normal, it would be obvious.The most proximal of Gilula's arcs is completely disrupted. The lunate no longer has the normal rectangular shape. It looks more like a piece of pie. A normal articular surface is evenly spaced, often with a sclerotic line. This cannot be said of the way that the lunate articulates with the scaphoid, the trapezium, or the capitate.Take a look at normal carpal bones to see if you can now spot the difference. Knowing the normal orientation of the lunate can tip one off to an important (not to be missed) abnormality—a lunate dislocation.Tip to Remember:A normal lunate never looks like a piece of pie (or pizza) on an AP wrist.​Published: 2/1/2022 9:04:00 AM
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs