title: Carpal Coalitions on Radiographs: Prevalence and Association With Ordering Indication.
abstract: OBJECTIVE
  Carpal coalitions are common and usually incidental to the indication for wrist radiographs. It is not clear if, or when, carpal coalitions cause pain. The aim of this study was to assess the prevalence of incidental carpal coalitions by evaluating radiographs taken for various indications and to test the association of demographic variables and ordering indications with the finding of a carpal coalition.
  
  
  METHODS
  We reviewed 1,119 posteroanterior wrist radiographs for the presence of carpal coalition. We used bivariate and multivariate analyses to assess demographic factors for their independent associations with the presence of carpal coalitions and to compare the difference in the prevalence of carpal coalitions between radiographs obtained to evaluate traumatic wrist pain (623 wrists), nontraumatic wrist pain (175 wrists), and other reasons (321 wrists).
  
  
  RESULTS
  Radiographs of 98 out of 1,119 patients (8.8%) showed a carpal coalition. Carpal coalitions were equally likely on radiographs obtained for traumatic wrist pain and nontraumatic wrist pain. Patients with no wrist trauma or wrist pain were less likely to have a carpal coalition on their radiograph.
  
  
  CONCLUSIONS
  We consider carpal coalitions an unlikely cause of wrist pain. The lower prevalence in radiographs obtained for causes other than wrist trauma or wrist pain remains unexplained, although it may be spurious. In the evaluation of a patient with nonspecific wrist pain, clinicians should be careful ascribing symptoms to anatomical variations on radiographs. These incidental findings should not usually affect management.
  
  
  METHODS
  Diagnostic III.
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Bastiaan T
authors.initials: BT
authors.lastname: van Hoorn
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Taylor
authors.initials: T
authors.lastname: Pong
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Wouter F
authors.initials: WF
authors.lastname: van Leeuwen
authors.affiliation: Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX. Electronic address: david.ring@austin.utexas.edu.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000000981:diagnostic imaging* / Q000209:etiology; D002348:Carpal Bones / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies; D013580:Synostosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014954:Wrist Injuries / Q000150:complications / Q000000981:diagnostic imaging; D055815:Young Adult
keywords: Carpal coalitions; pain; prevalence; radiograph indication; wrist