Disorders of the lunotriquetral joint Atlas of the Hand by David S. Ruch

By David S. Ruch

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Additional resources for Disorders of the lunotriquetral joint Atlas of the Hand Clinics - Volume 9, Number 1, March 2004

Sample text

5. Arthroscopic view of a Geissler Type II tear of the lunotriquetral interosseous ligament as seen with the arthroscope in the radial midcarpal portal. The lunotriquetral interosseous ligament was convex as seen in the radiocarpal portal, and the lunate and triquetrum are no longer congruent in the midcarpal space with increased play between the carpals. seen along the junction of the articular disk to the capsule. This may obscure the peripheral tear. Usually a shaver is brought in through the 6-R portal to debride the synovitis, revealing the peripheral tear [11].

When there is loss of tension, the disk has a sunken appearance and is soft when palpated with a probe. A peripheral tear of the articular disk then should be suspected [10]. Frequently, when a peripheral tear exists, hypertrophic synovitis is Fig. 2. Arthroscopic view of the normal concave appearance between the lunate and triquetrum as seen with the arthroscope in the 6-R portal. B. Geissler / Atlas Hand Clin 9 (2004) 39–58 Fig. 3. Arthroscopic view of the normal congruent relationship between the lunate and triquetrum as seen from the midcarpal row with the arthroscope in the radial midcarpal portal.

Some patients describe a painful crepitation with ulnar deviation of the wrist. Symptomatic injuries exhibit point tenderness directly over the lunotriquetral interval and, with peripheral tears, the TFC complex over the prestyloid recess. Pain usually is aggravated with ulnar deviation and supination. Patients with peripheral tears to the articular disk of the TFC complex frequently hurt right at the prestyloid recess. This pain may be accentuated by hyper pronation and supination of the wrist.

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