Accessory ossicles of the wrist

Last revised by Dr Payam Riahi on 09 Sep 2022

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:

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

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

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Cases and figures

  • Ossicles of the wrist and hand (illustration)
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  • Figure 1: all the ossicles
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  • Figure 2: ossicles around the carpometacarpal joint
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  • Figure 3: ossicles around the scaphoid
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  • Figure 4: ossicles of the wrist and hand
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  • Case 1: os hypolunatum
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  • Case 2: accessory ossicle of wrist (paranavicular)
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  • Case 3: epipyramis
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