Accessory ossicles of the wrist

Accessory ossicles of the wrist are commonly seen on plain radiographs of the wrist and associated cross-sectional imaging. Over 20 were originally described 2, although the more common include 1:

A handy mnemonic is LOTTEO.

The full list 2 can be broadly split into three groups: those around the carpometacarpal joints, those around the scaphoid and those around the lunate.

The distal row, from ulnar margin to radial margin are:

  • os vesalianum
  • os ulnare externum
  • os hamuli proprium
  • secondary capitate
  • gruber ossicle
  • os styloideum
  • secondary trapezoid
  • trapezium secondarium
  • os paratrapezium

The ossicles that surround the scaphoid (starting at the radioscaphoid joint and working anti-clockwise):

  • paranavicular
  • os radiostyloideum (persistent radial styloid)
  • os radiale externum
  • epitrapezium
  • os centrale carpi

The ossicles that surround the lunate (starting at the scapholunate joint and working anti-clockwise):

  • os hypolunatum
  • os epilunatum
  • epipyramis
  • accessory bone between lunate and triquetrum
  • lunula
  • os triangulare
  • persistent ulnar styloid
  • small bony element at the radioulnar joint

Upper limb anatomy
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Article Information

rID: 23575
Section: Anatomy
Synonyms or Alternate Spellings:
  • Accessory ossicle of the wrist

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     All the ossicles
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    Distal row of oss...
    Ossicles around the carpometacarpal joint
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    The ossicles arou...
    Ossicles around the scaphoid
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    Ossicles of the wrist and hand
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