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NBME 24 Answers

nbme24/Block 3/Question#39 (reveal difficulty score)
A 34-year-old woman is brought to the ...
Lunate ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: MSK

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 +10  upvote downvote
submitted by โˆ—neonem(629)
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Falling on outstretched hand: scaphoid is most common one to be fractured, lunate is most common to be dislocated. Lunate dislocation can cause acute carpal tunnel syndrome.

Think of the mnemonic "Straight Line To Pinky, Here Comes The Thumb" for the bones of the palm, drawing a football shape starting below the thumb MCP joint adjacent to the radius, then moving to your medial wrist, and then back to the thumb.

Scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid, trapezium. The lunate looks like it's posteriorly dislocated here.

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sympathetikey  Yep. I didn't even look at the X-ray. +12
dr.xx  loonies love lunate +2
wes79  she landed on her "right hand", but the X-ray is showing a left hand?? +1
wes79  i legit have no idea whats going on in that xray lol +11
nbme4unme  X-ray confused the hell out of me, I was going to put lunate based on Q stem but ended up putting Pisiform because it looks like that's what's messed up in the photo? Should have ignored the picture haha. +1
nwinkelmann  for @dr.xx, love your mnemonic. I added to it, or at least found an explanation on why it works. "loonies love lunate" and "loonies" are "dislocated" from reality. +3
niboonsh  Some Lovers Try Positions That They Cant Handle +13
vsn001  ngl if scaphoid was an option - would've sprung at that real quick -> thanks for teaching me the importance of knowing to look for dislocation vs fracture :D +
regularstudent  Ahh, the classic "left hand" x-ray but actual fracture of "right hand" NBME tactic +
sars  I think the x-ray is showing the lunate protruding out of the palmar side. Imagine the situation where you are falling and using your hand to stop the fall. Your lunate will dislocate forward as the rest of the carpal bones recoil back, hence why it protrudes through the palmar side. Thats why it causes an acute carpal tunnel syndrome. +
makingstrides  Another mnemonic, Some Lovers Tried Positions, That They Can't Handle +
ineedhelpwitmed  so long to pinky, here comes the thumb +
srmtn  in an X Ray (unless is marked) you can not know if is left or right. this is a lunate dislocation but actually is dorsal...even though they put in the stem that is anterior... please google "gilula lines" in order to fastly check a wrist X-ray and find a dislocation... also I think that a good clue when wrist trauma is: dislocation is usually lunate and necrosis is usually scaphoid. hope it helps +



 +1  upvote downvote
submitted by โˆ—pingra(6)
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Check out UWORLD question 16595 - The X-ray is showing the "spilled T cup" sign

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pingra  which is specific for a lunate dislocation* +



 +0  upvote downvote
submitted by jucapami(14)
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https://radiopaedia.org/articles/carpal-bones worth taking a look

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