El Paso's Chiropractic Team
I hope you have enjoyed our blog posts on various health, nutritional and injury related topics. Please don't hesitate in calling us or myself if you have questions when the need to seek care arises. Call the office or myself. Office 915-850-0900 - Cell 915-540-8444 Great Regards. Dr. J

Wrist/Hand Arthritis And Trauma: Diagnostic Imaging | El Paso, TX.

Wrist & Hand Trauma

  • Distal Radius & Ulnar Fractures (Colles, Smith’s, Barton’s, Chauffeur’s, DiePunch)- complicated by 50% ulnar styloid Fx, TFC path, DRUJ dislocation, scapholunate lig dissociation, lunate/perilunate dislocation )
  • Carpal bones Fracture & dislocations (scaphoid, triquetrum, hamate Fx &Lunate/perilunate dislocation)
  • Ligaments dissociation (Scapholunate dissociation, Lunotriquetral instability) 
  • Metacarpal & Phalangeal fractures (Bennett, Rolando, Game keeperFx/Stener lesion, Boxer Fx) 
  • Pediatric wrist injury (green-stick Fx, Torus Fx, Bowing/plastic deformity, Salter-Harris injuries) 
  • In all cases, Orthopedic hand surgical referral is required
wrist hand diagnostic imaging el paso tx.
  • Colles fx: m/c d/t FOOSH+pronation. m/c inOSP/elder women. Rare in men and if occurs need DEXA to avoid hip Fx etc. Young pts: high-energy trauma. Typically extra-articular.50%-cases show Ulna styloid (US) Fx. 
  • Complications: dinner fork deform, CRPS, DJD, nerve entrapment. 
  • Imaging: x-rad is sufficient, CT in complex Fx, MRI helps with ligament tears and TFC. 
  • Rx: if extra-articular and <5-mm distal radius shortening and <5-degree dorsal angulation closed reduction+casting is sufficient. ORIF in complex cases. 
  •  Image Dx: distal rad impaction/shortening,dorsal angulation of distal fragment, carefully examine if intra-articular extension, 50% US Fx
wrist hand diagnostic imaging el paso tx.
  • Smith Fx: Goyrand in French literature. Considered as reversed Colles, otherwise almost identical I.e. 85% extra-articular, 50%US Fx, OSP/elder women, young pts-high-energy trauma. Differences: mechanismFOOSHwith flexed wrist thus m. less frequent.
  • Imaging steps: (see Colles Fx) C
  • Complications: similar to Colles Fx 
  • Rad Dx: 85% extra-articular with volar(anterior) angulation of the distal fragment,radial shortening. Carefully examine cortical breach suspecting intra-articular extension that can be named as Smith type 2 or Reversed Barton Fx (next) 
  • Rx: similar approach as in Colles.
wrist hand diagnostic imaging el paso tx.
  • Barton fx: FOOSH, impaction of distal radius similar to Colles but the Fx line extends from the dorsal radial aspect into radiocarpal joint resulting with dorsal slip/dislocation of the carpus. 
  • Imaging: 1st sept x-radiography often with CTto examine intra-articular Fx extension and operative planning 
  • Rad Dx: distal radius Fx extending from dorsal into the radiocarpal joint with a variable degree of displacement, the proximal slip of the carpus 
  • If Fx line extends from the volar aspect into the wrist joint named Reversed Barton aka Smith type 2 (above bottom image)
  • Complications: similar to all distal radius Fx 
  • Rx: operative with ORIF
wrist hand diagnostic imaging el paso tx.
  • Chauffeur’s/backfire Fx aka Hutchinson Fx: intra-articular Fx of Radial styloid. The name derives from the time when the car had to be started with a hand crank that could backfire inducing wrist dorsiflexion and radial deviation.
  • Imaging: x-radiography is sufficient. CT may be helpful if Fx not readily shown by x-rays.
  • Complications: non-union, malunion, DJD,scapholunate dissociation,lunate/perilunate dislocation 
  • Rx: operative with percutaneous lagscrewin all cases d/t intra-articularnature
wrist hand diagnostic imaging el paso tx.
  • Die-Punch Fx: impaction Fx by the Lunate bone into distal articularLunate fossa of the Radius. IntraarticularFx. Derives its name from a technique to shape (impress) a hole in industrial machining “die-punch”.FOOSH injury.
  • Imaging: 1st step x-rays, may be equivocal d/t subtle depression of the Lunate fossa then CT scanning is most informative. 
  • Rad Dx: impacted lunate fossa region with intra-articular Fx extension. This can present as a comminuted Fxarticular Fx of the Distal Radius. 
  • Rx: operative d/t intra-articular Fx
wrist hand diagnostic imaging el paso tx.

Construct arcs of Gilula when evaluating carpal injuries. An Important step required to avoid missing subtle changes in carpal alignment and cortical continuity

wrist hand diagnostic imaging el paso tx.
  • Scaphoid bone Fx: m/c Fx carpal bone. D/tFOOSH wrist extended radially deviated. Location of Fx is most important to prognosis: Waist-m/c location (70%). May have 70-100%chance of AVN. Proximal pole Fx: 20-30% with a high risk of non-union. Distal pole-10%shows better prognosis. Distal pole Fx is m/c in children. Key clinical sign; pain in the snuffbox.
  • Imaging: 1st step-x-radiography but 15-20%missed d/t occult Fx. Special views required. Thus MRI is the most sensitive and specific for early occult Fx. Bone scintigraphy has98/100% specificity & sensitivity esp. 2-3 days after the onset. Key rad. Dx: Fx line if evident, displacement and obscuration of scaphoid(navicular) fat pad, examine for scapholunate dissociation. If proximal bone appears sclerotic-AVN occurred. MRI: low on T1 & high on T2/STIR/FSPD d/t bone edema, a low signalFx line can be noted. 
  • Rx: Spica cast should be applied if clinically suspected even w/o x-ray findings. For waistFx-cast for 3-mo for prox pole 5-mo immobilization. ORIF or percutaneous pinning with a Herbert screw.

Scapholunate Ligaments Dissociation

wrist hand diagnostic imaging el paso tx.
  • SNAC wrist: scaphoid non-union advanced collapse. Often d/t non-union and dissociation of scapholunate ligaments (SLL)with progressive radiocarpal and intercarpalDJD. The Proximal scaphoid fragment is attached to Lunate with distal dissociating and rotating‘signet ring” sign on x-rays.
  • SNAC wrist may often result in DISI
  • Rx: progressive DJD may lead to four-corner arthrodesis
wrist hand diagnostic imaging el paso tx.
  • Scapholunate advanced collapse (SLAC wrist): SLLdissociation with progressive intercarpal and radiocarpal DJD and volar or dorsal carpal displacement (DISI & VISI). Causes: trauma, CPPD, DJD, Kienboch disease (AVN of Lunate), Preiserdisease (AVN of Scaphoid).
  • SLL dissociation will lead to Dorsal or VolarIntercarlate aka Intercarpal Segmental Instability (DISIor VISI).
  • Rad Dx: Dx underlying cause. X-rays demonstrate dorsal or volar angulation of the Lunate with increased or decreased scapholunate angle on the lateral view. On frontal view: Terry Thomas sign or widening of scapholunate distance 3-4-mm as the upper limit of normal.
  •  MRI may help with ligament evaluation and pre-surgical planning
  • Rx: often operative with late DJD. Four-corner arthrodesis
wrist hand diagnostic imaging el paso tx.
  • Triquetrum Fx: 2nd m/c carpal bone Fx. M/C dorsal aspect is avulsed by tough Dorsal radiocarpal ligament. Cause: FOOSH.
  • Imaging: x-radiography wrist series are sufficient. Best revealed on the lateral view as an avulsed bone fragment adjacent to the dorsum of the Triquetrum. CT may help if radiographically equivocal. 
  • Rx: conservative care 
  • Complications: rare, may persist as pain on the dorsum of the wrist
wrist hand diagnostic imaging el paso tx.
  • Hook of the Hamate Fx: m/c occurs in batting sports (cricket, baseball, hockey, impact by a golf club etc.) 2% of carpusFx.
  • Imaging: x-radiography may fail to detect an Fx unless “carpal tunnel view” is used. CT may help if x-rays unrewarding.
  • Clinically: pain, positive pull test, weak painful grip. Deep ulnar n. branch may be affected within the Guyon canal. 
  • Rx: usually non-operative, but chronic non-union may require excision. 
  • DDx: bipartite hamate
wrist hand diagnostic imaging el paso tx.
  •  Lunate vs. Perilunate dislocation: Lunate is m/c dislocated carpal bone. Overall infrequent carpal injury. However, often missed!
  • Occurs with FOOSH and wrist extended and ulnar deviated. Imaging: 1st step x-rays. Ifunrewarding or require more complex injury evaluation CT scanning.
  • Key Rad DDx: DDx Lunate from perilunate dislocation. Lunate dislocation: lunate lost its contact with distal radius ‘spilled teacup” on the lateral. Perilunate dislocation: Lunate maintains its contact with distal radius despite the Capitatedorsally dislocated. Lunate dislocation is additionally helped to identify a “pie sign” d/t Lunate overlapping the Capitate
  • Rx: emergency reduction and operative repair of torn ligaments

Metacarpal & Phalangeal Injuries

wrist hand diagnostic imaging el paso tx.
  • Bennett Fx: intra-articular but noncomminuted impact-type Fx of the base of 1st MC bone of the thumb. Xradiographyis sufficient.
  • Rad Dx: characteristic triangular fragment of bone on the ulnar aspect of the 1st MCbase, often with radial subluxation of the remaining radial aspect of the 1st MC 
  • Complications: DJD, non-union etc. 
  • Rx: prone to instability/non-union requiring an operative care 
  • Rolando Fx: aka comminuted Bennett with Y or T-configuration. More complex injury. It is unstable requiring operative care
wrist hand diagnostic imaging el paso tx.
  • Gamekeeper thumb: traditionally described as a chronic tear of the ulnar (medial) collateral ligament at 1stMCP in English Gamekeepers’ who performed neck twisting/killing of small game. An acute injury may also be named as Skier’s thumb. This injury can be ligamentous w/o a fracture and/or an avulsion injury at the 1st proximal phalanx base. 
  • Complication: Stener lesion or displacement of torn ligament over Adductor pollicis muscle that cannot heal w/o surgical repair. MRI Dx is required. 
  • Avoid thumb stress views that can induce a Stenerlesion
  • Imaging: x-radiography followed by MRI to Dx Stenerlesion. MSK US can be used if MRI unavailable. 
  •  Stener lesion on MRI & MSUS: ulnar collateral stump is more superficial to Adductor pollicis aponeurosis and appears like a low signal mass-like stump forming so-called “yo-yo on the string sign” reported both on MRI and MSK US. 
  • Rx: often operative
wrist hand diagnostic imaging el paso tx.
  • Boxer Fx: m/c MC Fx. An extra-articular usually non-comminuted or minimal comminuted Fx through m/c the 5th and sometimes the 4th MCneck-head junction (occasionally through the shaft) resulting in volar head angulation. Mechanism: direct impact as in clenched fist punching hard surface (e.g facial bones/wall punching) hence 95% in young males. 
  • Imaging: x-radiography hand series is sufficient 
  • Rad Dx: Fx line transverse or oblique through MCneck with volar head angulation. Evaluate the degree of displacement, critical to report. 
  • Rx: typically non-operative with short –arm gutter splint and digits flexed. (www.aafp.org/afp/2009/0101/p16.html)
  • N.B. If the same mechanism fractures the 2ndand 3d MC in the same anatomic area it may require operative care.
wrist hand diagnostic imaging el paso tx.
  • Phalangeal hand Fx: m/c skeleton Fx (10% of all Fx). Sports and industrial injuries dominate
  • Imaging: x-radiography with hand series or PA/lateral finger views will suffice
  • Rad Dx: if prox phalanx Fx, distal fragment is angled volarly with prox fragment dorsally. Distal phalanx may be angled dorsally. Key observation: nail bed injury, which considered an open Fx with a risk of infection. 
  • Rx: if <10-degree angulation-buddy-taping with motion rehab. CRPP vs ORIF can be considered in complex cases-Orthopedic hand surgeon referral
  • Complication: loss of motion, necrosis, infection.May result with amputation 
  • For additional common injuries: PIP is m/c dislocated joint. Mullet (Baseball) finger, Jersey finger and other injury refer to: 
  • www.aafp.org/afp/2012/0415/p805.html
wrist hand diagnostic imaging el paso tx.
  • Felon: septic infection of the fingertip pulp typically with Staph.Aureus. Causes: needle prick(diabetics), paronychia, nail splinters etc. m/c in index and thumb, presenting with pain, swelling etc. 
  • D/t specific pulp anatomy theinfection>swelling leads to pulp compartment syndrome-pressure and necrosis. 
  • Rx: operative with incision distal to DIP, irrigation/debridement

Pediatric Wrist Injury

wrist hand diagnostic imaging el paso tx.
  • Incomplete Fx: Greenstick Fx, Torus (Buckle)Fx, Bowing (Plastic) deformity/Fx. D/t FOSHe.g. fell off the monkey bar. m/c affects <10-years-old.
  • Key Imaging diagnosis: degree of angulation/displacement, epiphyseal growth plate injury (Salter-Harris classification)
  • Rx: usually non-operative (closed reduction and casting)
wrist hand diagnostic imaging el paso tx.
  • Distal Radioulnar Joint (DRUJ) Instability-common injury following trauma as in FOOSHwith wrist hyperextension and rotation and disruption of DRUJ ligaments and TFCcomplex. Avulsion of ulnar styloid with the dorsal or volar displacement of distal ulnar should be noted.
  • Imaging steps: x-rays initially, MRI may identify ligaments and TFC damage, MSKUS can help with ligaments tearing.
  • Note: isolated DRUJ volar (top image) and dorsal (bottom image) dislocation.

Wrist & Hand Arthritis

wrist hand diagnostic imaging el paso tx.
  • Wrist DJD-typically secondary to trauma, scapholunate dissociation, SLAC, SNAC wrist, CPPD, Keinboch or Preiser Disease and others.
  • May lead to major functional loss
  • Imaging: typically presents as radiocarpal JSL, subchondral sclerosis,osteophytosis, subcortical cysts, and loose bodies. Typically additional induces intercarpal degeneration and particularly Tri-scaphe joint.
  • MRI may be helpful with early recognition of scapholunate dissociation, Lunate/Navicular AVN.
  • Rx: conservative vs. operative.
wrist hand diagnostic imaging el paso tx.
  • DJD Hand: Extremely common. True primary OA. MCP-never affected w/o DIP & PIP
  • If isolated MCP OA noted considerCPPD & Hemochromatosis (Hook-like osteophytes)
  • Clinically:
  • Mid-age females
  • Typically painless except 1st CMC OA
  • DIPs-Heberden nodes, PIPs-Bouchard nodes
  • Erosive OA (occasionally called“inflammatory OA”)
  • A Spectrum of OA but producing central proximal erosions at DIPs and PIPsresulting with very characteristic “gullwing” appearance. No systemic inflammation (no CRP, RF, Anti-CCP Ab)typically in middle-aged/elderly females, like Hand OA, often seen in families

Rheumatoid Arthritis

wrist hand diagnostic imaging el paso tx.
wrist hand diagnostic imaging el paso tx.
wrist hand diagnostic imaging el paso tx.
Post Disclaimers

Professional Scope of Practice *

The information herein on "Wrist/Hand Arthritis And Trauma: Diagnostic Imaging | El Paso, TX." is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.

Blog Information & Scope Discussions

Our information scope is limited to Chiropractic, musculoskeletal, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.

We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.

Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.*

Our office has reasonably attempted to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez, DC, or contact us at 915-850-0900.

We are here to help you and your family.

Blessings

Dr. Alex Jimenez DC, MSACP, RN*, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License # TX5807, New Mexico DC License # NM-DC2182

Licensed as a Registered Nurse (RN*) in Florida
Florida License RN License # RN9617241 (Control No. 3558029)
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Presently Matriculated: ICHS: MSN* FNP (Family Nurse Practitioner Program)

Dr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
My Digital Business Card

Comments are closed.

Again, I Welcome You.

Our Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive, cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, practical strength training, and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.

We use Specialized Chiropractic Protocols, Wellness Programs, Functional & Integrative Nutrition, Agility & Mobility Fitness Training, and Rehabilitation Systems for all ages.

As an extension to effective rehabilitation, we too offer our patients, disabled veterans, athletes, and young and elder a diverse portfolio of strength equipment, high-performance exercises, and advanced agility treatment options. We have teamed up with the city’s premier doctors, therapists, and trainers to provide high-level competitive athletes the possibility to push themselves to their highest abilities within our facilities.

We’ve been blessed to use our methods with thousands of El Pasoans over the last three decades allowing us to restore our patients’ health and fitness while implementing researched non-surgical methods and functional wellness programs.

Our programs are natural and use the body’s ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, unwanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, a positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living.

With a bit of work, we can achieve optimal health together, no matter the age or disability.

Join us in improving your health for you and your family.

It’s all about: LIVING, LOVING & MATTERING!

Welcome & God Bless

EL PASO LOCATIONS

East Side: Main Clinic*
11860 Vista Del Sol, Ste 128
Phone: 915-412-6677

Central: Rehabilitation Center
6440 Gateway East, Ste B
Phone: 915-850-0900

North East Rehabilitation & Fitness Center
7100 Airport Blvd, Ste. C
Phone: 915-412-6677

Dr. Alex Jimenez DC, MSACP, CIFM, ATN, IFMCP
My Digital Business Card

Clinic Location 1

Address: 11860 Vista Del Sol Dr Suite 128
El Paso, TX 79936
Phone
: (915) 412-6677
Email: Send Email
Webwww.DrAlexJimenez.com

Clinic Location 2

Address: 6440 Gateway East, Building B
El Paso, TX 79905
Phone: (915) 850-0900
EmailSend Email
Webwww.ElPasoBackClinic.com

Clinic Location 3

Address: 1700 N Zaragoza Rd # 117
El Paso, TX 79936
Phone: (915) 850-0900
EmailSend Email
Webwww.ChiropracticScientist.com

Push As Rx Crossfit & Rehab

Address: 6440 Gateway East, Building B
El Paso, TX 79905
Phone
: (915) 412-6677
EmailSend Email
Webwww.PushAsRx.com

Push 24/7

Address: 1700 E Cliff Dr
El Paso, TX 79902
Phone
: (915) 412-6677
EmailSend Email
Webwww.PushAsRx.com

Just Play 24/7

Address: 7100 Airport Blvd
El Paso, TX 79906
Phone
: (915) 412-6677
EmailSend Email
Webwww.JustPlay.us

Your New Rehabilitation & Fitness Center*

(Come Join Us Today)

Rated Top El Paso Doctor & Specialist by RateMD* | Years 2012 thru 2022

Top Rated Chiropractor El Paso

EVENTS REGISTRATION: Live Events & Webinars*

(Come Join Us & Register Today)

No Events Found

Call (915) 850-0900 Today!

Additional Online Links & Resources (Available 24/7)

  1. Online Appointments or Consultations:  bit.ly/Book-Online-Appointment
  2. Online Physical Injury / Accident Intake Form: bit.ly/Fill-Out-Your-Online-History
  3. Online Functional Medicine Assessment: bit.ly/functionmed
  1. General Disclaimer *

    The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, or licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

    We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

    Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

    email: coach@elpasofunctionalmedicine.com

    phone: 915-850-0900

    Licensed in: Texas & New Mexico*

    Dr. Alex Jimenez DC, MSACP, CIFM, IFMCP, ATN, CCST
    My Digital Business Card

Post Disclaimers

Professional Scope of Practice *

The information herein on "Wrist/Hand Arthritis And Trauma: Diagnostic Imaging | El Paso, TX." is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.

Blog Information & Scope Discussions

Our information scope is limited to Chiropractic, musculoskeletal, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.

We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.

Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.*

Our office has reasonably attempted to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez, DC, or contact us at 915-850-0900.

We are here to help you and your family.

Blessings

Dr. Alex Jimenez DC, MSACP, RN*, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License # TX5807, New Mexico DC License # NM-DC2182

Licensed as a Registered Nurse (RN*) in Florida
Florida License RN License # RN9617241 (Control No. 3558029)
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Presently Matriculated: ICHS: MSN* FNP (Family Nurse Practitioner Program)

Dr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
My Digital Business Card