Scapholunate dissociation

Background

• Most commonly injured ligament of the wrist
• Injury most commonly occurs from FOOSH

Clinical Features

• Pain/swelling on radial side of wrist
• "Clicking" sensation with wrist movement

Diagnosis

• Imaging
  • A grip compression view or wrist in ulnar deviation may be necessary in addition to PA/lateral views
  • Any of the following signs may be seen:
    • Widening of the scapholunate joint space >3mm
    • Rotary subluxation of the scaphoid
      • Lateral view: Scapholunate angle >60 degrees
      • PA view: Cortical ring sign (circular cortex of the bone is more prominent)
    • Dorsal intercalated segment instability
      • Dorsal angulation of lunate relative to radius resulting in capitolunate angle > 20°
      • Seen as loss of the normal collinear arrangement of the capitate, lunate, and radius

Treatment

• Radial gutter splint or short arm volar posterior mold
• Ortho referral

Images

• Black arrow: Scapholunate joint space widening
• White arrow: Cortical ring sign

• Dorsal intercalated segment instability

Source

• Tintinalli