Scapholunate dissociation: Difference between revisions

Latest revision as of 06:29, 6 July 2019

Background

Caused by rupture of scapholunate ligament
- 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

Evaluation

Imaging

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

Dorsal intercalated segment instability

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
  - Known as Terry-Thomas sign (or David Letterman sign)
- 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

Differential Diagnosis

Carpal Dislocations

Carpal fractures

AP view

Management

Radial gutter splint or forearm volar splint
Ortho referral

Disposition

Generally outpatient follow-up

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Most commonly injured ligament of the wrist
+*Caused by rupture of scapholunate ligament
+**Most commonly injured ligament of the wrist
 *Injury most commonly occurs from FOOSH
@@ Line 7: / Line 8: @@
 *"Clicking" sensation with wrist movement
-==Diagnosis==
+==Evaluation==
-*Imaging
+===Imaging===
-**A grip compression view or wrist in ulnar deviation may be necessary in addition to PA/lateral views
+[[File:Scapholunate Dissociation.jpg|thumb|Black arrow: Scapholunate joint space widening; White arrow: Cortical ring sign]]
-**Any of the following signs may be seen:
+[[File:Dorsal_Intercalated_Segment_Instability.jpg|thumb|Dorsal intercalated segment instability]]
-***Widening of the scapholunate joint space >3mm
+*A grip compression view or wrist in ulnar deviation may be necessary in addition to PA/lateral views
-***Rotary subluxation of the scaphoid
+*Any of the following signs may be seen:
-****Lateral view: Scapholunate angle >60 degrees
+**Widening of the scapholunate joint space >3mm
-****PA view: Cortical ring sign (circular cortex of the bone is more prominent)
+***Known as Terry-Thomas sign (or David Letterman sign)
-***Dorsal intercalated segment instability
+**Rotary subluxation of the scaphoid
-****Dorsal angulation of lunate relative to radius resulting in capitolunate angle > 20°
+***Lateral view: Scapholunate angle >60 degrees
-****Seen as loss of the normal collinear arrangement of the capitate, lunate, and radius
+***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==
+==Differential Diagnosis==
-*Radial gutter splint or short arm volar posterior mold
+{{Carpal dislocation DDX}}
-*Ortho referral
-==Images==
+{{Carpal fractures}}
-*Black arrow: Scapholunate joint space widening
-*White arrow: Cortical ring sign
-[[File:Scapholunate Dissociation.jpg]]
+==Management==
+*[[Radial gutter splint]] or [[forearm volar splint]]
+*Ortho referral
-*Dorsal intercalated segment instability
+==Disposition==
-[[File:Dorsal_Intercalated_Segment_Instability.jpg]]
+*Generally outpatient follow-up
-==Source==
+==References==
-*Tintinalli
+<references/>
-[[Category:Ortho]]
+[[Category:Orthopedics]]