Case 36 Answer: SLAC wrist. The distal radius luceny is a fake out (I wouldn’t give you multiple diagnoses would I? :) )

This may have been hard since you were unable to blow up the image, but the key finding is the abnormal proximal carpal row. Where’s the lunate? It’s shoved way over laterally and capitate has migrated proximally to be adjacent to the scaphoid and almost articulating with the radius.

SLAC (scapholunate advanced collapse) is the end stage of a torn scapholunate ligamant which yields instability of the carpus and allows the above finds to occur. Brief write-up: http://mskcases.com/index.php?module=article&view=89

More than you wanted to know about carpal instability: http://www.radiologyassistant.nl/en/p42a29ec06b9e8/wrist-carpal-instability.html