Carpal synostoses combinations have been reported between mostly all of the carpal bones with lunotriquetrum followed by capitohamate being the most frequent and Scaphotrapezial synostosis is the rarest type [8-12].
O'Rahilly, "A survey of carpal and tarsal anomalies," The Journal of Bone and Joint Surgery, vol.
Special radiographic projections such as carpal
tunnel, scaphoid or supinated oblique view are indicated if routine AP and lateral views fail to demonstrate a fracture (5).MRI is reported to be a second-step imaging method in patients whose radiographs are negative or indistinct (6).MRI not only shows the fracture line but also shows marrow edema within the pisiform bone indicating fracture (5,6).
So just what are the factors that influence the pressure in the carpal tunnel that can be associated with CTS?
* Anatomically, a variation in the hook of the hamate bone (part of the floor in the carpal tunnel) was more often found in study subjects with CTS compared with the group without CTS.
With the carpal box method less bone-to-bone over-lap is visible on the radiograph compared to routine images of the wrist.
Regrettably, the carpal box apparatus is not available in most imaging departments.
(1,12) Once stage four is reached, the remainder of the carpus may reduce over the radius with the lunate resting in the carpal tunnel.
These patients frequently report median nerve distribution paresthesia and acute carpal tunnel syndrome has been reported in up to 25% of perilunate injuries.
The ulnar carpal bone and the accessory carpal bone also articulate with the distal extremities of ulna.
There were five metacarpal bones lying between the carpal bones and the digits.
They include acute tenosynovitis, carpal tunnel syndrome, tophi deposition in the palm, punched-out lytic lesions; and involvement of the metacarpals.
Carpal tunnel syndrome associated with mixed calcium pyrophosphate dihydrate and apatite crystal deposition in tendon synovial sheath.
This report will highlight a case of symptomatic carpal bossing in an elite eighteen year old hockey player and examine the relevant diagnosis, anatomy, etiology, pathophysiology, and the role of conservative management for symptomatic carpal bossing.
A treatment plan consisting of reassurance and education on symptomatic carpal bossing to reduce fears of a more ominous wrist injury and Active Release Technique (ART[R]) soft tissue therapy of the extensor carpi radialis longus and brevis, extensor digitorum and extensor retinaculum was instituted twice weekly for two weeks.