Scapholunate dissociation: Difference between revisions
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==Background== | ==Background== | ||
* Caused by rupture of scapholunate ligament | *Caused by rupture of scapholunate ligament | ||
**Most commonly injured ligament of the wrist | **Most commonly injured ligament of the wrist | ||
*Injury most commonly occurs from FOOSH | *Injury most commonly occurs from FOOSH | ||
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*"Clicking" sensation with wrist movement | *"Clicking" sensation with wrist movement | ||
== | ==Evaluation== | ||
===Imaging=== | |||
[[File:Scapholunate Dissociation.jpg|thumb|Black arrow: Scapholunate joint space widening; White arrow: Cortical ring sign]] | |||
[[File:Dorsal_Intercalated_Segment_Instability.jpg|thumb|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== | ==Differential Diagnosis== | ||
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{{Carpal fractures}} | {{Carpal fractures}} | ||
== | ==Management== | ||
*Radial gutter splint or | *[[Radial gutter splint]] or [[forearm volar splint]] | ||
*Ortho referral | *Ortho referral | ||
== | ==Disposition== | ||
* | *Generally outpatient follow-up | ||
==References== | |||
<references/> | |||
[[Category:Orthopedics]] | |||
[[Category: | |||
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
- 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
- Widening of the scapholunate joint space >3mm
Differential Diagnosis
Carpal Dislocations
Carpal fractures
- Scaphoid fracture
- Lunate fracture
- Triquetrum fracture
- Pisiform fracture
- Trapezium fracture
- Trapezoid fracture
- Capitate fracture
- Hamate fracture
Management
- Radial gutter splint or forearm volar splint
- Ortho referral
Disposition
- Generally outpatient follow-up