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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*Any of the following signs may be seen: | *Any of the following signs may be seen: | ||
**Widening of the scapholunate joint space >3mm | **Widening of the scapholunate joint space >3mm | ||
*** Know as Terry-Thomas sign (or David Letterman sign) | ***Know as Terry-Thomas sign (or David Letterman sign) | ||
**Rotary subluxation of the scaphoid | **Rotary subluxation of the scaphoid | ||
***Lateral view: Scapholunate angle >60 degrees | ***Lateral view: Scapholunate angle >60 degrees | ||
Revision as of 22:50, 4 July 2016
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
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
- Know 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
Treatment
- Radial gutter splint or forearm volar splint
- Ortho referral
Disposition
- Generally outpatient followup