Positive carpal sign

Last revised by Henry Knipe on 17 Aug 2023

The positive carpal sign is a useful radiographic sign for the diagnosis of Turner syndrome in association with other musculoskeletal manifestations. Abnormality in the shape of the proximal carpal row in the dorsopalmar radiographs of the wrist and hand (taken in the neutral position is key to the sign).

Measurement

Two tangent lines must be drawn, the first touching the proximal contour of the scaphoid and lunate bones and the second touching the triquetral and lunate bones. The intersection of these tangents resulted in an angle called the carpal angle

Interpretation

When there is an abnormal angular shape of the proximal carpal row and the carpal angle is ≤117° this is called the positive carpal sign 4. Although a positive carpal sign may be seen in ~5% of the normal population, the incidence of this sign in gonadal dysgenesis (e.g. Turner syndrome) is ~10x higher than in normal subjects 4.

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