What is a Triquetrolunate Injury?
Triquetrolunate injuries are injuries to the small triquetrum and lunate bones of the wrist. The lunate and the triquetrum comprise the ulnar side of the proximal carpal row at the wrist. Ligaments such as the lunotriquetral (LT) ligament support this joint.
Types of Triquetrolunate Injuries
Triquetrolunate injuries refer to any instability that occurs in the ligament complex connecting the small triquetrum and lunate bones of the wrist, usually due to a hard fall in a contact sport such as basketball or football.
Such injuries include:
- Extensor carpi ulnaris subsheath tear
- Triangular fibrocartilage complex tear
- Joint dislocations/complications.
- Distal radio-ulnar joint dislocations/subluxation
- Joint instability due to high-grade ligament tear
Characteristics and Clinical Presentation of Triquetrolunate Injuries
Instability of the lunotriquetral joint. Lunotriquetral ligament and dorsal radiocarpal ligament may be ruptured. Ulnar side presents with pain that is worse with supination, extension and ulnar deviation.
Some of the most common symptoms of triquetrolunate injuries include:
- Clicking sound with movement
Causes of Triquetrolunate Injuries
Triquetrolunate injuries can occur from a fall onto an outstretched hand with the arm. The arm may be externally rotated with the forearm supinated, and the wrist is extended and ulnarly deviated.
This stresses the LT joint and can cause tearing of the fibers of the LT ligament, resulting in painful swelling, inflammation, and tenderness. Sudden force from a door can also result in triquetrolunate sprains.
Getting a Diagnosis for Triquetrolunate Injuries
Radiographs are appropriate for this kind of injury. They may reveal a deviation from satisfactory alignment of the proximal carpal row. An MRI may be required to further check ligamentous tissue. Physical examination is paramount in diagnosing the degree of injury and whether or not there is a need for additional imaging.
Treatment Options for Triquetrolunate Injuries
Mild cases may be treated with rest, temporary immobilization, and occupational therapy. Immediate pain relief is aided by reducing inflammation with NSAIDs. More severe cases may require arthroscopically assisted surgery to restore joint realignment and function.
Immobilization with a static wrist orthosis or use of a product to assist with boosting the pisiform to provide external support to the joint may be beneficial. A corticosteroid injection may provide temporary, immediate pain relief. However, surgical intervention may be required in severe cases.
Surgical reconstruction may be required to re-align the lunocapitate while restoring the integrity of the proximal carpal row. Lunotriquetral ligament reconstruction or arthroscopically assisted ligament repair may be required.
Immediate medical supervision following an injury resulting from a fall can aid in providing the best prognosis possible. Chronic or severe injuries may deteriorate over time when left untreated.
Preventing Triquetrolunate Injuries
Because triquetrolunate injuries often result from a sudden fall, it can be difficult to prevent this kind of injury. Proper body mechanics when falling may help prevent injuries to the wrist.
Prognosis for Triquetrolunate Injuries
Low grade injuries treated with conservative means can recover well after a period of immobilization. Injuries requiring surgical intervention require immobilization followed by physical therapy to optimize recovery.
Your hand surgeon will be able to instruct you on an individual basis what your injury will require in terms of healing time and physical therapy to maximize function and mobility.
If You Believe You Have a Triquetrolunate Injury, Contact HandSport Surgery Institute
Please contact us to schedule an appointment with our talented team. People experiencing a triquetrolunate injury should be evaluated to try to limit further injury and mobility issues.
If you have been injured, it’s important to be evaluated by a highly skilled wrist surgeon. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.