Patient History
25M with acute pain in left wrist. Fell through a trailer landed on outstretched hands.
Findings
ALIGNMENT:
Ulnar Variance posture: Neutral.
Carpal Instability: 9 mm diastasis of the scapholunate interval.
ARTICULATIONS:
Scapholunate joint: The scaphoid is dissociated from the motion of the lunate and is tilted volar. The lunate is dorsally tilted. Concomitant rotatory subluxation of the scaphoid consistent with tear or failure of the radioscaphocapitate or sling ligament.
Thumb Carpometacarpal Joint: Normal.
Scaphotrapeziotrapezoidal Joint: Normal.
Pisiform-Triquetral Joint: Normal.
Radiocarpal Joint: Normal.
Distal Radioulnar Joint: Normal.
Carpal Effusion: Large joint effusion or hemarthrosis.
Distal Radioulnar Joint Effusion: None.
INTRINSIC LIGAMENTS:
Scapholunate Ligament: The dorsal, proximal (membranous) and volar components are torn.
Lunotriquetral Ligament: Intact.
Triangular Fibrocartilage: The TFCC, disc proper, foveal, styloid attachments and meniscus homologous are intact.
Lunate Facet: Normal.
Hamate-Lunate Facet: Normal.
Extensor Compartment:
I: Abductor pollicis longus and extensor pollicis brevis and intact.
II: Extensor carpi radialis longus and brevis are intact.
III: Extensor pollicis longus is intact.
IV: Extensor digitorum communis is intact.
V: Extensor digiti minimi is intact.
VI: Focal tendinosis and interstitial delamination of the extensor carpi ulnaris at the ulnar styloid.
Flexor Compartment: Normal.
Carpal Tunnel: No space-occupying lesions.
Median Nerve: Normal.
Flexor Retinaculum:
Flexor Tendons: Normal.
Guyon's Canal: No space-occupying lesions.
OTHER FINDINGS:
Skeleton: No acute fractures.
Soft Tissues: Diffuse periarticular soft tissue swelling.
Vessels: Normal neurovascular bundles.
Impressions
1. Complete tear of the anterior, proximal and dorsal components of the scapholunate ligament with diastasis of the scapholunate interval.
2. Dorsal intercarpal segmental instability (DISI). Concomitant rotatory subluxation of the scaphoid consistent with tear or failure of the radioscaphocapitate or sling ligament.
3. Large joint effusion or hemarthrosis.
4. Focal tendinosis and interstitial delamination of the extensor carpi ulnaris at the ulnar styloid.
