1. Managing Minor Musculoskeletal Injuries and Conditions First Edition. David Bradley. © 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd. Companion website: www.wiley.com/go/bradley/musculoskeletalwww.wiley.com/go/bradley/musculoskeletal

2. Hand X-rays

3. Hand 1 Thumb infection, not healing. What do you see? See my notes below.

4. Hand 2 What do you see on this X-ray? When you have finished studying the film, read my notes below.

5. Hand 2 – enlarged view The arrows point to two chip fractures. This is a blow-up of the previous X-ray. Do you see how easy it is to miss a fracture? Unless you cover all the film, even the next finger along is suspect.

6. Hand 3 Fracture separation of the epiphysis of the TP right index finger, with anterior tilting. See notes below.

7. Hand 3 – enlarged view On the lateral view the blue line shows the normal alignment of the TP and the yellow the alignment as it is now following the fracture. The epiphysis (still in its normal position) is arrowed on the left hand AP view.

8. Hand 4 Quite a lesson to be learnt here. Notice the glass foreign body. They have a tendency to hide from you and even local pressure will sometimes not cause pain because the fragment is ‘cushioned’ inside a tiny haematoma. Read more about it in Chapter 8 of the book (my arrow points to the tiny FB).

9. Hand 5 History of drinking and arguing with someone the previous evening; woke up with a painful hand, but doesn’t remember how it happened. Do you see anything abnormal? After a thorough look, read my notes below.

10. Hand 5 - an enlarged view The blue line shows the normal alignment of the bone, the yellow one the alignment of the fractured distal fragment. See my notes below.

11. Hand 6 What do you see here? See my notes below.

12. Hand 7 A history of getting the hand trapped in a slammed car door. It has an associated wound - ouch! What do you see? What does the yellow arrow point to? What bone does the white arrow point to? After you have studied the film, read my comments below.

13. Hand 7 – enlarged view This is a blow-up of the previous X-ray. The overlapping shadows make it very difficult to get a clear view of the two bones on X-ray, but here the yellow lines partly outline the fifth MC shaft and distal joint surface for you.

14. Hand 8 What do you see? There is a history of this young man falling onto his outstretched hand. See my notes below.

15. Hand 8 – enlarged view Bennett fracture close up. The yellow lines approximate the fracture surfaces, the arrow the direction the thumb metacarpal was forced.

16. Hand 9 What do you see? See my comments below.

17. Hand 9 – enlarged view This is a blow-up of the third, fourth and fifth MCP joints of the right hand. Starting on the extreme right, the fifth joint space is still present and the joint looks normal. Compare with the fourth now: the joint is narrowed with white at the edges (eburnation) and an osteophyte curling out (arrow). Finally, the third joint is completely chaotic. There is no joint space remaining. Cysts are present throughout. I can feel the pain just looking at it.

18. Hand 10 What do you see here? The patient has had long-term pain in his hand, which today got crushed in machinery at work. Now, please see my comments below.