Triquetrolunate 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

• Radiograph positive
  • Hand and finger fractures
  • Hand and finger dislocations
  • Triquetrolunate ligament instability
• Radiograph negative
  • Dupeytren contracture
  • Boutonniere deformity
  • Hand and finger tendon injuries
  • Ganglion cyst
  • De Quervain tenosynovitis
  • Intersection syndrome
  • Drummer's wrist
  • Extensor digitorum tenosynovitis
  • Vaughn Jackson syndrome
  • Snapping Extensor Carpi Ulnaris
  • Compressive neuropathy, "bracelet syndrome"
  • Scaphoid fracture
  • Osteoarthritis
  • Infiltrative tenosynovitis
  • Gout
  • Rheumatoid arthritis
  • Trigger finger
  • Mallet finger
    • Swan neck deformity
  • Jersey finger
  • Jammed finger
  • Subungual hematoma
  • Fingertip laceration
  • Metacarpophalangeal (MCP) ulnar ligament rupture (Gamekeeper's thumb)
  • Nail avulsion
  • High-pressure injection injury

Evaluation

• Note: subtle injuries may have normal radiographic appearance
• Imaging
  • Lateral
    • Volar intercalated segment instability is seen
      • Lunate tilts palmar producing zigzag pattern opposite of scapholunate injury
  • PA
    • Widening of the triquetrolunate joint space

Management

• Ulnar gutter splint or short arm posterior mold; referral to orthopedist

References

Authors

Jordan Swartz, Ross Donaldson, Daniel Ostermayer, Neil Young