1. Normal Variants of the Elbow

2. Olecranon Foramen aka Supratrochlear Foramen

3. Olecranon Foramen

4. Radioulnar Synostosis usually bilateral may decrease supination or pronation

5. Supracondylar Process An osseous projection on the anteromedial aspect of the distal humerus Struther’s ligamentStruther’s ligament may extend inferior from this process to the medial epicondyle may cause neurovascular signs or symptoms

6. Fracture of Supracondylar Process

7. Ununited Secondary Ossificatio n Center - Medial Epicondyle

8. Pseudotumor appearance of the Radial Tuberosity

9. The Wrist

10. Standard Wrist Series PA Wrist Medial Oblique Wrist Lateral Wrist

11. PA Wrist Note the overlap between the trapezium and the trapezoid

12. PA Wrist

13. Medial Oblique Wrist No overlap between the trapezium and the trapezoid

14. Lateral Wrist

15. - the third metacarpal, capitate, lunate and radius should form a straight line

16. Age of Carpal Appearance Capitate and Hamate:at birth-6 mo Triquetrum:.5 yr-3.5yrs Lunate:1.5-4.5yrs Scaphoid:3-9yrs Trapezium:3-9yrs Trapezoid:3-9yrs Pisiform7-13yrs Distal radial epiphysis:.5-2yrs(19) Distal ulnar epiphysis:5.5-9.5yrs(18)

17. Pronator Quadratus Fat Stripe Not visualized or may be displaced following trauma

18. Accessory Views of the Wrist

19. PA Wrist with Ulnar Deviation

20. Carpal Tunnel Projection

21. Three Arcs of Carpal Alignment Along proximal aspect of proximal row Along distal aspect of proximal row Along proximal aspect of distal row

22. Intercarpal Distances 2mmThe joint spaces between the carpal bones should not exceed 2mm 2mmthe distal radioulnar joint space should not exceed 2mm

23. Normal Variants

24. Carpal Coalition Fusion between the capitate and hamate possibly involving the triquetrum and pisiform

25. Carpal Coalition

26. Accessory Ossicle Distal to Ulna Ununited secondary ossification center of the ulnar styloid process. Most likely represents old un-united fracture.

27. Pie Sign

28. Negative Ulnar Variance 1-2mm shorterNormally the ulna should be no more than 1-2mm shorter than the radius predisposes lunate to avascular necrosis

29. Madelung’s Deformity Delayed growth of medial distal radius may result in a posterior subluxation of the ulna and the “bayonette” appearance. Carpal angle >117°.

30. Madelung’s Deformity

31. Thank You