0:01

Um, are there any, uh, questions for us?

0:05

The question, uh, is, uh, do

0:09

mid carpal compartment

0:10

and piso triquetral joints communicate?

0:13

And the answer is normally, uh, they do not.

0:16

And if you remember, I showed you

0:18

and one of those initial grams where that did occur,

0:23

and that relates to a distal lesion of Palmer one C

0:28

related to often the distal disruption

0:32

of the ul no triquetral, the lar ul triquetral ligament,

0:36

which can produce in fact communication

0:40

between the pisiform triquetral and mid carpal compartments.

0:44

But normally they do not communicate.

0:48

Do you use on no carpal compartment?

0:53

I don't understand that one. Well, I don't use,

0:55

I don't, the on no carpal compartment

0:59

I gather you're talking about the ulnar aspect

1:01

of the radial carpal compartment.

1:04

Uh, I don't use that as a term

1:06

because I use these various spaces.

1:09

I call them compartments, usually not joints

1:12

and the nar carpal areas a space not a uh, compartment.

1:16

But you're right that I think some people might use

1:20

that when there's abutment,

1:21

but I don't think it's a good term.

1:24

I don't use it either. The next one is, I struggle

1:26

with the T one coronal signal in the TFCC

1:30

or QFCC.

1:32

Uh, your term is catching on

1:34

and some of the MRI studies, I see it shows some ill-defined

1:39

smudge like ghost signal in the TFC,

1:42

but the coronal PD fat set is reasonably, uh, normal

1:46

with regard to its internal fibers.

1:48

Any advice on this? Am I missing a chronic injury?

1:52

Uh, or is it just a normal T one?

1:54

And remember we discussed, I I think earlier

1:57

and throughout the course that as you age a couple

2:00

of things, uh, happen to you, you dry out a little bit,

2:04

unfortunately you desiccate

2:06

and things start to crack a little bit.

2:09

And you also can, can coincidentally accumulate

2:13

or sub clinically accumulate things like CPPD in some

2:17

of these fibro cartilaginous like structures.

2:20

So it is not uncommon at all in my experience,

2:23

to see signal in the TFC or in the menisci of the knee.

2:27

And as long as they're central

2:29

and there are no secondary signs

2:30

and the morphology is preserved,

2:33

I will either dismiss them out of hand, uh,

2:36

call them intrasubstance signals

2:38

or call them degenerative,

2:39

depending upon what's happening in the neighborhood. Don?

2:42

Yeah, we turn to mucin as we get older.

2:45

And, uh, I think mucin and OID changes in the TFC

2:50

and discs and in menisci are common.

2:54

And I think if you see gentle graying on a T one weighted

2:59

sequence, it's probably in an older person,

3:01

it's probably degenerative in, in nature.

3:04

So with age, you're allowing me to pick

3:05

between brittle and mucin. I'm not sure

3:08

There are a lot of bad things.

3:09

I think I'm gonna pick brittle.

3:12

Okay. We have a precise, uh, okay. I think that's for you.

3:16

They have something there for your name on it.

3:21

I don't think so, do we? Well, why, what is,

3:23

why is mine say Dr.

3:25

Steven Pomerance would like to answer?

3:28

Is that just coming up on my, I don't know.

3:30

I that I, What are the precise criteria

3:33

to diagnose ECU subluxation on MRI?

3:38

Uh, I was worried about the length of these lectures today,

3:42

and I took out a slide

3:43

that would've answered this particular question precisely

3:47

because the position of the ECU with respect

3:51

to the ulnar steroid depends upon the position

3:54

of the wrist at the time of imaging,

3:56

whether it is pronated neutral

3:58

or supinated, you can tell

4:01

that if you look on your axial images

4:03

where the ulnar styloid is,

4:05

if the ulnar styloid is located superiorly dorsally,

4:10

S per s sper supinated,

4:13

if it's pointing straight down toward the vola aspect

4:16

of the wrist, it's pronated.

4:17

And if it's pointing medially, it's kind

4:20

of neutral In the supinated position, you get a couple

4:24

of changes, one of which is a little bit of displacement.

4:27

I don't know if I want to call it subluxation of the ECU

4:31

with respect to the yl.

4:33

So you have to be a little bit careful

4:36

if there's extensive supination at the time of imaging.

4:40

Now, one other thing, and again, i I I should have had

4:43

that slide that the ulnar head translates

4:47

with respect to the radius and the degree

4:50

and direction of translation that is normal, uh, varies

4:55

between supination and pronation.

4:58

The general rule is the ulnar head moves away from the yl,

5:03

so if it's supinated, the OID is up

5:05

and the ulnar head will translate slightly downward.

5:08

And the opposite for pronated.

5:11

Uh, I don't use the other part

5:13

with something about Superman positioning.

5:15

You wanna talk about that.

5:17

Um, one of the pro, um, well, in terms

5:20

of the ECU subluxation, one other comment I will say is

5:23

as we get a little bit bit older,

5:25

the sub sheath will demonstrate a little bit of stripping.

5:28

And I don't mind in an older person,

5:30

especially in certain positions for the ECU

5:33

to perch a little bit on, on the, on their styloid, as long

5:37

as there's no swelling

5:38

or inflammation in the, in the neighborhood.

5:41

Um, the Superman position, uh,

5:44

I don't use it very frequently for this diagnosis

5:47

'cause I don't need it.

5:48

I don't need that kind of spatial detail and resolution.

5:51

I use the Superman position when I'm dropping a, a one

5:56

or two inch coil on a specific area of interest,

5:59

including a finger where I,

6:01

I will use the Superman position quite readily.

6:04

Remember, it's very hard for most people, you know,

6:07

50, 60, 70 year olds to lie here like this for

6:10

for 30 minutes, you know, they get shoulder pain

6:12

and shoulder impingement.

6:14

But again, I will use the Superman position

6:17

with my microscopy coil as we'll see tomorrow

6:20

for high resolution finger imaging.

6:23

Okay, I think we have reached the end of today's program.

6:27

Uh, uh, we welcome you back tomorrow.

6:30

The main speakers will be Dr.

6:32

Chung and Mills, and there'll be talking on the hand

6:36

and fingers and, uh, things of that sort.

6:39

So that's gonna be the most, uh, distal, uh,

6:44

part of this particular course.

6:46

Thanks for attending.

6:47

And we look forward to, uh, seeing you again.

6:50

Uh, tomorrow we're gonna

6:52

Do a, a brief piece on the er.

6:56

Okay. Okay. So we are not stopping.

6:59

We are al we are almost stopping. Okay.

7:01

And just, just so that we complete, uh,

7:04

your request from yesterday, um,

7:09

in 30 seconds or less,

7:10

I think you were asking about the anatomy of the ERUs

7:14

fibrosis, which

7:15

by the way is a very critical structure in horses.

7:18

It merges with the extensor carp radialis.

7:22

Um, and together they, they provide some insertion

7:26

and support on the cannon bone, but this is a human being.

7:31

And one thing that isn't that well recognized is

7:34

that when the lacer uh, forms at the myotendinous junction,

7:39

it separates from the biceps, which keeps going.

7:42

It's over top of it, but then it deviates,

7:44

it deviates off to the side.

7:47

It takes, takes an oblique course on the medial side

7:51

and forms a sheep over the pronator terries.

7:54

Now where that becomes relevant is in individuals

7:57

that have had injuries to the ERUs

7:59

and the pronator terries,

8:01

it may encroach on the median nerve

8:03

and they may end up with pronator terries

8:06

entrapment neuropathy.

8:07

So-called honeymoon paralysis.

8:09

And with that, we will take leave of you for the evening.

8:13

Thanks all for your attention.