Lunotriquetral Instability

Other Names

• Lunotriquetral Ligament Injury
• Volar Intercalated Segment Instability
• VISI

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Background

• Involves injury to the Lunotriquetral Ligament, which secures the relationship between the Lunate and Triquetral
• Radiotriquetral Ligament may also be injured
• Occurs much less commonly than scapholunate ligament injuries

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Pathophysiology

• Traumatic injury with wrist in hyperextension or extension and radial deviation

---

Risk Factors

• Unknown

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Differential Diagnosis

• Fractures
  • Distal Radius Fracture
    • Barton's Fracture
    • Chauffer's Fracture
    • Colles' Fracture
    • Die-Punch Fracture
    • Radial Styloid Fracture
    • Smith's Fracture
  • Distal Ulna Fracture
  • Carpal Fractures
    • Scaphoid Fracture
    • Lunate Fracture
    • Triquetrum Fracture
    • Pisiform Fracture
    • Trapezium Fracture
    • Trapezoid Fracture
    • Capitate Fracture
    • Hamate Fracture
  • Essex Lopresti Fracture
• Dislocations
  • Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
  • Carpometacarpal Joint Dislocation
  • Distal Radioulnar Joint Dislocation
  • Lunate Dislocation
  • Perilunate Dislocation
• Instability & Degenerative
  • Scapholunate Instability
  • Lunotriquetral Instability
  • Scaphoid Nonunion Advanced Collapse
  • Distal Radial Ulnar Joint Instability
  • Kienbocks Disease
  • Dorsal Wrist Impingement
• Tendinopathies & Ligaments
  • De Quervain's Tenosynovitis
  • Intersection Syndrome
  • TFCC Injury
  • Wrist Tendinopathies
  • Extensor Carpi Ulnaris Instability
• Neuropathies
  • Carpal Tunnel Syndrome
  • Pronator Teres Syndrome
  • Anterior Interosseus Nerve Syndrome
  • Posterior Interosseus Nerve Syndrome
  • Guyon Canal Syndrome
• Pediatric Considerations
  • Distal Radial Epiphysitis (Gymnast's Wrist)
  • Torus Fracture
• Arthropathies
  • Wrist Osteoarthritis
  • Rheumatoid Arthritis
  • Gout
• Cartilage
  • Osteochondral Defect
• Vascular
  • Hypothenar Hammer Syndrome
• Other
  • Ganglion Cyst of Wrist
  • Ulnar Impingement Syndrome
  • Infectious Tenosynovitis

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Clinical Features

• History
  • Needs to be updated
• Physical Exam: Physical Exam Wrist
  • Pain, swelling, carpal tenderness
• Special Tests
  • Kleinmans Shear Test: shearing force across LT joint
  • Reagans Test: Applying opposing forces to lunate and triquetrum

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Evaluation

Radiographs

• Standard Radiographs Wrist
• May be normal on initial evaluation
• Lateral view: Scapholunate angle < 30°, VISI deformity
• AP: break in Gilulas Lines or the carpal alignment

Arthroscopy

• May be required if suspicion is high as radiographs can be normal

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Classification

• N/A

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Management

Nonoperative

• Indicated at discretion of hand surgeon

Operative

• Indications
  • Acute instability
  • Chronic instability

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Return to Play

• At discretion of surgeon

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Complications

• Volar intercalated segmental instability (VISI)

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See Also

• Internal
  • Forearm Pain (Main)
  • Wrist Pain (Main)
  • Hand and Wrist Anatomy (Main)
  • Physical Exam Wrist
• External
  • Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/

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