The lunate is a central bone in the wrist that is important for proper movement and support of the joint (Figure 1). A 45-year-old male injures his wrist during Live Action Role Play in Chicago two weeks ago. Volar pole fractures are more commonly observed as the lunate is compressed by the capitate. Both images from . Summary. - Discussion: The injury pattern may involve a crush injury, a FOOSH injury (Figure 18.21), or a direct blow to the dorsal aspect of the wrist. The combination of a capitate fracture and a scaphoid waist fractureis known as "scaphocapitate syndrome" . AP and lateral radiographs of the wrist are shown in figures A and B respectively. SLAC (scaphoid lunate advanced collapse) and SNAC (scaphoid nonunion advanced collapse) are the most common patterns seen. commonly missed (~25%) on initial presentation, occurs when wrist extended and ulnarly deviated, disruption of capitolunate articulation -->, disruption of lunotriquetral articulation -->, failure of dorsal radiocarpal ligament -->, ligamentous disruptions with associated fractures of the radius, ulnar, or carpal bones, lunate stays in position while carpus dislocates, lunate forced volar or dorsal while carpus remains aligned, major stabilizers of the proximal carpal row, ligaments the both originate and insert among the carpal bones, + lunotriquetral disruption, "perilunate", Lunate dislocated from lunate fossa (usually volar), median nerve symptoms may occur in ~25% of patients, most common in Mayfield stage IV where the lunate dislocates into the carpal tunnel, due to palmar rotation from dorsal force of carpus, loss of colinearity of radius, lunate, and capitate, no indications when used as definitive management, universally poor functional outcomes with non-operative management, emergent closed reduction/splinting followed by open reduction, ligament repair, fixation, possible carpal tunnel release, decreased grip strength and stiffness are common, chronic injury (defined as >8 weeks after initial injury), not uncommon, as initial diagnosis frequently missed, chronic injuries with degenerative changes, finger traps, elbow at 90 degrees of flexion, dorsal dislocations are reduced through wrist extension, traction, and flexion of wrist, longitudinal incision centered at Lister's tubercle, excellent exposure of proximal carpal row and midcarpal joints, extended carpal tunnel incision just proximal to volar wrist crease, some believe volar ligament repair not necessary, difficulty regaining digital flexion and grip, controversy of k-wire versus intraosseous cerclage wiring, repair of lunotriquetral interosseous ligament, decision to repair based on surgeon preference as no studies have shown improved results, short arm thumb spica splint converted to short arm cast at first post-op visit, duration of casting varies, but at least 6 weeks, perform via dorsal and volar incisions if median nerve compression is present, volar approach allows median nerve decompression with excision of lunate, dorsal approach facilitates excision of the scaphoid and triquetrum, radiodense appearance of the lunate on radiograph reported in up to 12.5% of cases, usually identified 1-4 months post-injury, - Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). Incompetence of which of the following anatomic structures is the most likely etiology of this finding? She also complains of some paresthesias in her thumb and index finger. Evaluation of volar compartment pressures with a needle monitor, Icing and elevation of the arm with follow-up evaluation in 8 hours, Immediate EMG evaluation of the left upper extremity, Closed reduction, carpal tunnel release, and sugar tong splinting, Emergent open reduction internal fixation with carpal tunnel release. What is the most appropriate next step in management? The other types are perilunate, trans-radial styloid and . Displaced impaction fracture of the lunate fossa. Radiographs are shown in Figures A and B. At the time of the index operation, there was no distal radioulnar joint instability after plating of the radius. Unable to process the form. Kienbock's disease is also known as avascular necrosis (AVN) of the lunate. ADVERTISEMENT: Supporters see fewer/no ads. A 17-year-old male falls from a retaining wall onto his left arm. The next best step in management would be: (OBQ12.163) A 32-year-old ballet dancer sustains a distal radius fracture, and is subsequently closed reduced and casted. (OBQ12.38) Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-10010, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":10010,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/lunate-dislocation/questions/1703?lang=us"}, Figure 1: Stage 4 of progressive perilunate, see full revision history and disclosures, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, Mayfield classification of carpal instability, dorsal intercalated segment instability (DISI), volar intercalated segment instability (VISI), scaphoid nonunion advanced collapse (SNAC), triangular fibrocartilaginous complex (TFCC) injuries, ulnar-sided wrist impaction and impingement syndromes, calcium pyrophosphate dihydrate deposition disease, Philips Australia, Paid speaker at Philips Spectral CT events (ongoing). He initially thought it was a sprain, but presents due to continued pain worsened by push-ups. Copyright 2023 Lineage Medical, Inc. All rights reserved. (SBQ17SE.70) -. Radiographs show a well-fixed fracture in good alignment. Diagnosis requires careful evaluation of plain radiographs. The lunate bone articulates with the scaphoid, the distal radius, and the TFCC. lunate fracture orthobulletswellesley, ma baby store. Carpal tunnel release if no resolution at 6-12 weeks. Diagnosis is confirmed with either a radiographic carpal tunnel view or CT scan. He underwent operative fixation by and presents to your clinic for his 2 week follow-up visit. The mechanism of injury is typically a fall onto an outstretched hand with a hyperextended wrist or during a . {"url":"/signup-modal-props.json?lang=us"}, Murphy A, Lunate fracture. Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF. Which of the following interventions should be taken? The swelling often causes a decrease in 2-point discrimination in the median nerve distribution due to acute carpal tunnel syndrome. Pathology. Diagnosis is made clinically and radiographically with orthogonal radiographs of the wrist, Treatment can be nonoperative or operative depending on fracture stability and fracture displacement as well as patient age and activity demands, accounts for 17.5% of all fractures in adults, younger patients due to high energy mechanisms, older patients due to low energy mechanisms (i.e. (2008) ISBN:1588904539. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. Surgery may be done to change forces across the lunate and wrist joint or to improve vascularity of the lunate. Changes for Fat Loss by with a free trial. Perilunate fracture-dislocations of the wrist, Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate, Orthopaedic Specialists of North Carolina. Now, he complains of worsening hand pain and sensory disturbances in his volar thumb and index finger. Diagnosis of DISI deformity can be made with lateral wrist radiographs showing a scapholunate angle > 70 degrees. Adhesions within the first and third dorsal wrist compartments. Distal Radius Fracture Non-Spanning External Fixator . immobilization in a short arm thumb spica cast. Two hours following closed reduction, the deformity is corrected, but the numbness and wrist pain is worsening. Radiographs are provided in Figure A. For more advanced stages, surgery is usually considered. Lunate fractures account for around 4% of all carpal fractures 1. (OBQ06.60) There is injury of all of the perilunate ligaments, most significantly the dorsal radiolunate ligament. Schmitt R, Lanz U, Buchberger W. Diagnostic Imaging of the Hand. Perilunate dislocations typically occur in young adults with high energy trauma resulting in the loading of a hyperextended, ulnarly deviated hand. A 40-year-old slips on the ice on a wintery Michigan day and sustains a comminuted intra-articular distal radius fracture. Check for errors and try again. The lunate is one of the eight small bones in the wrist. The injury is closed and she is neurovascularly intact. The patient shows you the lateral film in Figure A. Diagnosis is made with PA wrist radiographs showing widening of the SL joint. 4. After completing instrumentation, radiocarpal screw penetration is best assessed on which fluoroscopic view? Lunate Dislocation (Perilunate dissociation) . Inability to extend the index finger proximal interphalangeal joint. Lunate dislocations typically occur due to a fall on an outstretched hand (or during a motor vehicle injury) where there is forceful dorsiflexion of the wrist 3. DISI (dorsal intercalated segmental instability), scapholunate dissociation causes the scaphoid to flex palmar and the lunate to dorsiflex, if left untreated the DISI deformity can progress into a, DISI deformity may also develop secondary to distal pole of the scaphoid excision for treatment of STT arthritis, DISI is a form of carpal instability dissociative, c-shaped structure connecting the dorsal, proximal and volar surfaces of the scaphoid and lunate bones, dorsal fiber thickened (2-3mm) compared to volar fibers, dorsal component provides the greatest constraint to translation between the scaphoid and lunate bones, proximal fibers have minimal mechanical strength, Overview of wrist ligaments and biomechanics, acute FOOSH injury vs. degenerative rupture, age, nature of injury, duration since injury, degree of underlying arthritis, level of activity, pain increased with loading across the wrist (e.g. (OBQ06.136) This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Diagnosis requires careful evaluation of plain radiographs. 28 (6): 1771-84. Dorsally displaced, extra-articular fracture. Distal radius fractures are themost common orthopaedic injury and generally result from fall on an outstretched hand. Radiographs are provided in Figures A-C. {"url":"/signup-modal-props.json?lang=us"}, Dixon A, Hacking C, El-Feky M, et al. Colles'. The patient undergoes closed reduction and splinting; however, her paresthesias worsen significantly in the next 12 hours. . Read millions of eBooks and audiobooks on the web, iPad, iPhone and Android. It works closely with the two forearm bones (the radius and ulna) to help the wrist move. Capitate fractures are typically seen with associated scaphoid fractures, distal radial fractures, or lunate injuries; they are rarely seen in isolation. The rest of the carpal bones are in a normal anatomic position in relation to the radius. The patient undergoes open reduction and internal fixation of the fracture. When the lunate is severely fracture, collapsed, or arthritic, salvage treatments such as lunate and other wrist bone removal may be necessary. Other common causes include: car . Diagnosis can be confirmed with orthogonal radiographs of the involve digit. Perilunate instability represents about 7 percent of all injuries to the carpus [ 5 ]. In very early stages, the treatment can be as simple as observation, activity changes, and/or immobilization. Which of the following is true post-operatively regarding this patient's ulnar styloid fracture? Volar pole fractures are more commonly observed as the lunate is compressed by the capitate. A 24-year-old stagehand fell 12 feet off of a ladder while preparing a set. Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF. The most important differential is of other carpal dislocations, particularly: In addition to stating that a lunate dislocation is present, a number of features should be sought and commented upon: ensure that radiolunate alignment is disrupted, and that you are not looking at a perilunate dislocation(stage II carpal dislocation), evaluate and comment on the degree or palmar rotation of the lunate (this can be up to 270 degrees)4, ensure that the capitate remains co-linear with the long axis of the radius, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Isolated fractures without displacement or subluxation can be managed conservatively, however fractures that possess joint subluxation are unstable and require surgical intervention 2. (OBQ06.102) In the Traumatological Hospital Meidling/Vienna, 12 patients with acute fractures of the lunate bone were treated between 1983 and 1993. What is the next best step in management of this patient? Wheeless' Textbook of Orthopaedics. The instrument touches a structure that prevents ulnar translocation of the carpus after a PRC. Check for errors and try again. Medical Information Search When he finally does, he is diagnosed with a perilunate dislocation and indicated for a Proximal Row Carpectomy (PRC). . Treatment of acute SL ligament injuries may be immobilization versus operative repair/reconstruction depending on degree of displacement. Fractures of the normal lunate--isolated or associated with fractures of the scaphoid or radius--are very rare. A 56-year-old male presents to your clinic with a 4-month history of inability to extend the IP joint of his thumb. (SBQ17SE.64) FlashCards My DeckMaster Create Card Deck . Greenberg's text-atlas of emergency medicine. Isolated capitate fractures are rare (scaphoid is most common associated fracture) Occurs via forceful dorsiflexion of hand (FOOSH injury) with impact on radial side; Proximal fracture fragment at risk for avascular necrosis; Clinical Features. At the time the article was created Andrew Dixon had no recorded disclosures. Urgent reduction and surgical repair of disrupted ligaments is required to prevent long-term joint dysfunction. main cause for these lesions is a direct impact against a hard surface with a, 4th or 5th metacarpal base fractures or dislocations, usually required to delineate fracture pattern and determine operative plan, diagnosis confirmed by history, physical exam, and, may be used for extra-articular non-displaced fracture, most fractures are intra-articular and require open reduction, interfragmentary screws +/- k-wires for temporary stabilization, fixation may be obtained with K wires or screws, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). What is the likely mechanism of her paresthesias and what is the most appropriate treatment? Treatment involves observation, NSAIDs and splinting in early stages of disease. Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx. A 51-year-old female presents with an acute inability to extend her thumb, four months after she was treated with cast immobilization for a minimally-displaced distal radius fracture. Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. Towson, MD 21204 Nerve compression; open reduction internal fixation with open carpal tunnel release, Nerve laceration; open reduction internal fixation with primary nerve repair or grafting, Decreased arterial inflow; fasciotomy with open reduction internal fixation, Nerve compression; repeat closed reduction. ORTHOBULLETS; Flashcards. What is the most appropriate treatment at this time? The lunate is displaced and rotated volarly. Data Trace is the publisher of What complication is most likely to occur in this patient? There may be other associated injuries that require further investigation via cross-sectional imaging 1,2. whilst on the lateral the capitate no longer sits in the lunate. Indications. Given the lunate's position in the wrist, there is significant overlap from other carpal bones and hence these fractures can be subtle. A 35-year-old professional football player complains of severe wrist pain after making a tackle. Lunate fracture. She presents 11 months later with the radiograph seen in Figure A, complaining of significant wrist pain. The lunate is made up of the volar pole, body, and dorsal pole. According to meta-analysis and systematic reviews, which of the following statements is most accurate regarding her injury? Treatment is designed to relieve pain and restore function.Your hand surgeon will advise you of the best treatment options and explain the risks, benefits and side-effects of various treatments for Kienbocks disease. Inability to flex the index finger proximal interphalangeal joint. These should not be confused with perilunate dislocations in which the radiolunate articulation is preserved and the rest of the carpus is displaced dorsally. Summary. Diagnosis is made clinically with progressive wrist pain and wrist instability with radiographs showing advanced arthritis of the radiocarpal and midcarpal joints (radiolunate joint spared). Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. (OBQ18.216) Post-operatively she is given a prescription with the goal of mitigating a potential adverse outcome. Wrist with Kienbock's disease and ulna that is short compared to radius, Using this search tool means you agree to the, 2023 American Society for Surgery of the Hand, from the American Society for Surgery of the Hand, Decreased motion or stiffness of the wrist. A 64-year-old female sustains a nondisplaced distal radius fracture and undergoes closed treatment using a cast. Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF. You review his operative note in which the surgeon reports having to apply a volar locking plate in a distal position to secure the difficult intra-articular fracture. 2.Meenalochani Shunmugam, Joideep Phadnis, Amy Watts, Gregory I. Bain. Most patients with Kienbocks disease have the following symptoms: The diagnosis of Kienbocks disease can often be made by reviewing your history, performing a physical examination, and taking x-rays. (OBQ09.254) A 45-year-old construction worker sustains a fall and presents with an isolated injury to his upper extremity. Overall, carpal dislocations comprise less than 10% of all wrist injuries. Volar wrist swelling is usually prominent. He was treated as a sprain and no further follow-up was planned. (OBQ08.179) Fracture geometry, particularly a jagged bone spike, can present a physical barrier in closed reduction of pediatric distal radius-ulna fractures. diastasis of the scapholunate complex occurs with complete SLIL tears and capsule disruption. Flashcards. toe phalanx fracture orthobulletsdaniel casey ellie casey. Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius. You can rate this topic again in 12 months. J Hand Surg Am. Failure to support the lunate facet with fragment specific fixation, Use of only three bicortical screws in the intact radial shaft proximally. Summary. 110 West Rd., Suite 227 Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Difficult wrist fractures. Depressed fracture of the lunate fossa (articular surface) Smith's. A 76-year-old male sustains a minimally displaced distal radius fracture and undergoes closed treatment with a cast. - most frequently dislocated carpal bone; Pearls/pitfalls. Mechanism of injury. (OBQ04.233) In P_STAR, 2 distraction pins are placed 1.5 cm proximal and distal to the fracture site in clearance of the distal radial physis. 2023 Lineage Medical, Inc. All rights reserved. Fourth and fifth proximal/middle phalangeal shaft fractures and select metacarpal fractures. What is this structure? 2.0 screw for a Scaphoid Hand Fracture How to palpate the . lunate fracture orthobullets 2023 Lineage Medical, Inc. All rights reserved. Twelve months after open reduction and internal fixation of a comminuted distal radius fracture as seen in Figure A and B, which of the following tendons is at greatest risk of rupture? Which of the following will best achieve anatomic reduction, restore function, and prevent future degenerative changes of the wrist? A 45-year-old male sustained a fall onto his right wrist 2 weeks ago. Lunate/perilunate dislocations are high energy injuries to the wrist associated with neurological injury and poor functional outcomes. Preoperatively, he reported some mild sensory disturbances in the volar thumb and index finger, but had 2-point discrimination of 6mm in each finger. What is the appropriate surgical treatment at this time? Upon discharge from the hospital the medication reconciliation includes an order for daily Vitamin C 500mg supplementation. The lunate is one of the eight small bones in the wrist. 2. Perilunate dislocations and fracture-dislocations are relatively uncommon injury patterns in acute wrist trauma. As he tried to brace his fall, he landed directly on his extended and ulnarly deviated left hand. The patient recovered well initially but presents after 6 months with grip weakness. Diagnosis is made with PA wrist radiographs showing widening of the SL joint. 1980;5 (3): 226-41. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. (2005) ISBN:0781745861. - tenderness of dorsal lunate may suggest Keinbock's dz, while moreulnar tenderness suggests tears of TFC or lunotriquetral ligament; The rest of the carpal bones are in a normal anatomic position in relation to the radius. It can be difficult to diagnose in its earlier stages. A fracture to the lunate may also be associated with injury to the TFCC. Lunate dislocationsare an uncommon traumatic wrist injury that require prompt management and surgical repair. A 65-year-old female sustains a fall onto her outstretched right hand. (SBQ17SE.13) You can rate this topic again in 12 months. He was taken to the local teaching hospital where radiographs were taken, shown in Figures A and B. If you are unsure, it is best to err on the safe side and call for help. Radiographic features The lunate bone articulates with the scaphoid, the distal radius, and the TFCC. - lunate, capitate, and the base of the 3rd metacarpal are in line w/each other & is covered by base of ECRB; The lunate is displaced and rotated volarly. How do you counsel him about his post-operative period? Lunate dislocations are an uncommon traumatic wrist injury that require prompt management and surgical repair. lunate fracture orthobullets Phalanx fractures of the hand are some of the most common fractures occurring in humans. (SBQ17SE.28) Treatment options depend upon the severity and stage of the disease. Scaphoid Lunate Advanced Collapse (S-LAC) - Hand - Orthobullets Scapholunate ligament - Wikipedia positive test seen in patients with scaphol-unate ligament injury or patients with liga-mentous laxity, where the scaphoid is no longer constrained proximally and sublux-ates out of the scaphoid fossa resulting in pain; when pressure removed from the Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. He is not able to see a physician for 4 months. A 28-year-old woman fell on her right wrist while rollerblading 6 days ago. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Electromyography and nerve conduction velocity studies, AP and lateral radiographs of the forearm, (SAE07SM.78) Hamate Body Fractures are rare carpal fractures that can be associated with 4th or 5th metacarpal fractures. comic book publishers accepting submissions 2022 Likes ; brady list police massachusetts Followers ; nurse injector training Followers ; transfer apple health data to samsung Subscriptores ; night shift vs overnight shift Followers ; big joe's funeral questions and answers His radiograph is shown in Figure A. scaphoid is flexed and lunate is extended as scapholunate ligament no longer restrains this articulation, lunate extended > 10 degrees past neutral, resultant scaphoid flexion and lunate extension creates, abnormal distribution of forces across midcarpal and radiocarpal joints, malalignment of concentric joint surfaces, describes predictable progression of degenerative changes from the radial styloid to the entire scaphoid facet and finally to the unstable capitolunate joint, as the capitate subluxates dorsally on the lunate, key finding is that the radiolunate joint is spared, unlike other forms of wrist arthritis, since there remains a concentric articulation between the lunate and the spheroid lunate fossa of the distal radius, Arthritis between scaphoid and radial styloid, Arthritis between scaphoid and entire scaphoid facet of the radius, While original Watson classification describes preservation of radiolunate joint in all stages of SLAC wrist, subsequent description by other surgeons of "stage IV" pancarpal arthritis observed in rare cases where radiolunate joint is affected, validity of "stage IV" changes in SLAC wrist remains controversial and presence pancarpal arthritis should alert the clinician of a different etiology of wrist arthritis, patients localize pain in region of scapholunate interval, tenderness directly over scapholunate ligament dorsally, will not be positive in more advanced cases as arthritic changes stabilize the scaphoid, with firm pressure over the palmar tuberosity of the scaphoid, wrist is moved from ulnar to radial deviation, positive test seen in patients with scapholunate ligament injury or patients with ligamentous laxity, where the scaphoid is no longer constrained proximally and subluxates out of the scaphoid fossa resulting in pain, when pressure removed from the scaphoid, the scaphoid relocates back into the scaphoid fossa, and typical snapping or clicking occurs, obtain standard PA and lateral radiographs, PA radiograph will reveal greater than 3mm diastasis between the scaphoid and lunate, PA radiograph shows sclerosis and joint space narrowing between scaphoid and the entire scaphoid fossa of distal radius, PA radiograph shows sclerosis and joint space narrowing between the lunate and capitate, and the capitate will eventually migrate proximally into the space created by the scapholunate dissociation, thinning of articular surfaces of the proximal scaphoid, scaphoid facet of distal radius and capitatolunate joint with synovitis in radiocarpal and midcarpal joints, NSAIDs, wrist splinting, and possible corticosteroid injections, prevents impingement between proximal scaphoid and radial styloid, may be performed open or arthroscopically via 1,2 portal for instrumentation, since posterior and anterior interosseous nerve only provide proprioception and sensation to wrist capsule at their most distal branches, they can be safely dennervated to provide pain relief, can be used in combination with below procedures for Stage II or III, contraindicated with caputolunate arthritis (Stage III SLAC) because capitate articulates with lunate fossa of the distal radius, contraindicated if there is an incompetent radioscaphocapitate ligament, excising entire proximal row of carpal bones (scaphoid, lunate and triquetrum) while preserving, provides relative preservation of strength and motion, also provides relative preservation of strength and motion, wrist motion occurs through the preserved articulation between lunate and distal radius (lunate fossa), similar long term clinical results between scaphoid excision/ four corner fusion and proximal row carpectomy, wrist fusion gives best pain relief and good grip strength at the cost of wrist motion, - Scaphoid Lunate Advanced Collapse (SLAC), Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease).
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