Lunotriquetral ligament instability

Background

Ulnar equivalent of the scapholunate ligament injury
May be confused with other causes of ulnar-sided wrist pain
Results from FOOSH with impact on hypothenar eminence

Clinical Features

Localized tenderness on ulnar aspect of wrist just distal to ulna

Differential Diagnosis

Hand and finger injuries

Distal finger
Other finger/thumb
- Boutonniere deformity
- Mallet finger
  - Swan neck deformity
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
Hand
- Dupuytren contracture
Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
General
- Hand and finger dislocations
- Hand and finger fractures
- Gout and Pseudogout
- Hand and finger tendon injuries
- High-pressure injection injury
- Osteoarthritis
- Rheumatoid arthritis

Evaluation

X-ray (note: imaging is often normal with this injury)
- PA - Widening of the triquetrolunate joint space
- Lateral - volar intercalated segment instability is seen
  - Lunate tilts palmar producing zigzag pattern (opposite of scapholunate injury)

Management

Ulnar gutter splint or short arm posterior mold
Refer to orthopedic surgery

Disposition

Discharge with ortho follow-up

See Also

References

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