Thread by @KaranChoudhry6

Mastering subtle radiological signs in wrist trauma help in diagnosing Carpal injuries

Unfortunately, we don’t get taught how to do this

Here are 6 important typical signs👇while assessing wrist injury Xrays to:

- Diagnose carpal injuries
- Counsel patient
- Avoid missing them

Sign #1: Gilula’s lines: 3 lines marking the arcs formed by the proximal and distal carpal rows

A carpal fracture (greater arc injury) or a carpal dislocation (lesser arc injury) leading to a ligament injury & disruption of arcs

Injuries are represented by arcs of vulnerability

Sign #2: Signet ring sign:

A ring like appearance over the distal portion of the scaphoid because of flexion.

The distal pole of the scaphoid overlaps on the waist.

It is indicative of scapholunate injury.

Sign #3: Terry Thomas sign:

Indicative of a Scapho lunate ligament injury on PA view.

It may or may not be as a result of inital propogation of the radial styloid fracture.

It resembles the teeth gap of the British comedian Terry Thomas.

Sign #4: Piece of pie sign :

Triangular appearance of the lunate because of going into extension.

Again indicative of scapholunate dissociation.

Sign #5: Apple in cup on a saucer sign:

Normally the capitate lies on the lunate that rests on the radius.

This collinearity of the carpal rows on the wrist joint resembles the appearance of the apple that is kept over a cup on a saucer.

Sign #6: Spilled tea cup sign:

In perilunate dislocation by the time the lunate subluxes anteriorly the remaining carpals get lined in position.

This gives an appearance of a cup where tea is about to spill.

This sign is indicative of a lurking median nerve compression

TL;DR: 6 radiological signs in carpus to be kept in mind for while assessing a wrist X-ray:

1. Gilula’s and Vulnerability lines,
2. Signet ring sign,
3. Terry Thomas sign,
4. Piece of pie sign,
5. Apple in cup on saucer sign,
6. Spilled tea cup sign

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