Carpal Bone Injuries Workup

Updated: Jan 11, 2016
  • Author: Bryan C Hoynak, MD, FACEP, FAAEM; Chief Editor: Sherwin SW Ho, MD  more...
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Laboratory Studies

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  • No laboratory studies are indicated in cases of isolated wrist injury. However, erythrocyte sedimentation rate analysis can be helpful for monitoring the degree of inflammation involved with a chronic wrist problem.


Imaging Studies

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  • The majority of wrist fractures can be assessed adequately with good-quality AP and lateral radiographic images. [11] The palmar slope of the articular surface of the distal radius is appreciated on a lateral x-ray film of the wrist. A slope of 11 º is normal.

  • For distal radius fractures, measure the palmar slope to assess the degree of angulation. Determine whether the fracture is intra-articular, and note the presence of any step-off at the articular surface. The ulnar styloid is chipped in approximately 60% of all patients with this fracture.

  • For scaphoid fractures, the fracture may be at the wrist, tuberosity, or proximal pole. If a scaphoid fracture is strongly suggested, a posteroanterior view of the scaphoid with the wrist in ulnar deviation may distract the fragments and make the fracture more apparent.

  • A bone scan or magnetic resonance imaging study may be necessary to detect occult fractures that may not be visualized on plain radiographs. [12, 13]