 And with that, I'll take some questions. So UCL is considered part of the TFC or not, the TFCC or not. TFCC is kind of a waste basket. So everything goes in there. So the ulnar collateral ligament is in most circles considered part of the TFCC. It's not a critically important structure since it doesn't provide a lot of instability. It's usually used as an indirect sign of other things that are happening, such as the case that I showed you. So the answer is it is. How reliable is various variance assessment on MRI? Doesn't patient positioning affect this? It absolutely does. You'll notice in my slides, I didn't say ulnar variance positive. I said positive variance posture because hand surgeons are like neurosurgeons. Detail oriented, thank God. OCD, not to a fault. They're OCD, thank God they are. So they are very specific about how they want their variance measured on conventional radiography. And that is why I use the term posture. However, you have an obligation to use a little bit of common sense. So let's say you're more than eight millimeters distal to the radius with your ulnar. Look at what's happening around you. If the TFC is thin, if there's fluid in the radial and articulation, if there is lunato-chondromylacia, you have an obligation to call out that ulnar positive variance posture to protect yourself and say that the patient has secondary signs of ulnal lunate abutment syndrome. So I absolutely use the secondary signs to put myself on sound footing as it relates to variants when dealing with hand surgeons who have very strict criteria for such. Which protocol would you recommend when evaluating a vitality of bone on MRI? For instance, in the case of Keenbox disease or a scaphoid fracture, is T1 fat sat before and after contrast injection sufficient or the only examination that can get the optimal and realistic results when we use perfusion sequences? Well, first of all, I wouldn't do perfusion imaging if I have a uniform or nearly uniform black, slightly collapsed or markedly collapsed, you know, lunate. Now, if somebody has a normal size lunate and it's an indeterminate Keenbox case or they're trying to determine how much is viable and how much is not viable, which wouldn't be in a uniform black lunate, then I will do dynamic contrast imaging just as I might do with say a breast MRI. I'll do very fast fat suppression gradient echo imaging and maybe a slice every three seconds or so. You don't have to be too quick with it and look at how the lunate perfuses. How often do I do that? Maybe two to three times a year. I've done it a few times in the scaphoid as well, but it isn't standard practice for me, but that's the best way to do it. Kind of mimicking the dynamic breast protocol. Next, please. Any other question? How much physiologic fluid is there in the distal radial ulnar joint? I allow a slit. What's a slit, a millimeter of fluid? There's gonna be some subjectivity there, but it's gonna be a very tiny amount and it's also gonna depend on patient age. For instance, if I have a 15 year old, I don't wanna see any fluid there. If I have a 50 year old, I'll allow a millimeter of lubricating fluid and potential overuse and so on. If I'm on the fence, I'm looking at everything else. I'm looking at the volar and dorsal radial ulnar ligaments. I'm looking at the intrinsic. I'm looking at the adjacent radial ulnar cartilage using indirect signs to make that decision. Next question, what is the significance of the space of pourier? Well, the space of pourier is this sort of weakness that occurs between those short volar blue ligaments that I drew for you that is kind of right in the middle just volar to decapitate. It is important because it's an area of weakness and when you have these more advanced complex instabilities, it will allow the capitate to come forward. It'll allow the capitate to drop down and it can contribute to what you saw at the end, end stage carpal tunnel syndrome. Orthopod tells you to look for ulnar collateral ligament injury. Where to look for it and is there any significance? Well, I'm not sure an experienced hand surgeon would ever order an MRI for that purpose. We all know that do a lot of risk imaging that the UCL is a flimsy structure. It is used by us as an indirect sign of other problems, retinacular stripping, ECU disease, and so on. But the best place to look for it is where I showed you on higher resolution coronal imaging. And it doesn't necessarily matter which sequence although I see it best on a one to two millimeter fiesta sequence. How reliable is TFCC interpretation on films or on scans done in other places? Do you end up repeating such scans at your place? That's a loaded question. You know, we are a tertiary referrals facility. So we do get to see and resolve these usually without contrast. And MR is extremely reliable, extremely reliable. I hardly ever inject a risk to diagnose a TFC tear. The most common use of contrast for me is in an equivocal LT ligament injury. And that is not often. A next question about Dissy and Vissy. Are there standard angles to measure the position of the lunate and scaphoid and capitate bones? There are. If you email me, I'll send you those angles. My pan is not working. But as a general rule of thumb, I like the scaphoid to have about a 45 to 60 degree position relative to the vertical. So if I start to see the scaphoid get below 45 degrees and start approaching the horizontal, then I know I have rotatory displacement. Regarding Dissy and Vissy, that's a little more easy. However, if the technologist puts the hand in the scanner and they do this, they all are deviate, you are going to create a Dissy posture appearance, so-called pseudo Dissy. So make sure that your wrist is absolutely straight. And if it is, your lunate should be pointed straight up towards the capitate and straight up towards the base of the third metacarpal. Let's see. Question about the ECU. Is the ECU part of the TFCC? It is, as is its subsheet. All right, are there any other questions? 1.5 versus 3T, which one is preferable? They're both fine, absolutely. And you can scan with low field in the wrist because you can get the hand in the center of the magnet bore. So if you can do the right sequences, stern, then section gradient echo imaging, Sarge, one, two millimeter slices, you absolutely can image the wrist at low field as low as 0.18 Tesla. Okay, I think I have answered all the questions. Doesn't patient positioning affect the ability to assess Dissy? I think I answered that one. You absolutely need to have the wrist straight. If you older deviate, you're gonna create pseudo Dissy. If you radial deviate, you're gonna create pseudo Dissy. All right, I think that's about it. Thank you for your thoughtful questions. And I hope to see you all in September for the combined Resnick-Pomerance, Chug and colleagues course. We're looking forward to seeing you. Have a great day.