Scapholunate Dissociation

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Contents

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 motion study 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

Scapholunate Dissociation.jpg


  • Dorsal intercalated segment instability

Dorsal Intercalated Segment Instability.jpg

Source

  • Tintinalli

Authors

Jordan Swartz