A 47-Year-Old Male with Chronic Wrist Pain and No Recent Trauma

The Resolution

Differential Diagnosis

• Kienböck’s disease
• Scaphoid impaction syndrome
• Scapholunate ligament tears
• Ligamentous wrist injury

Diagnosis

This patient was diagnosed with ligamentous wrist injury. Note rupture of the scaphoid ligaments in the images.

Learnings/What to Look for

• A gap of >3 mm between the lunate and scaphoid (also called Terry Thomas or Lauren Hutton sign)
• This injury results from trauma and is the leading cause of scapholunate advanced collapse

Pearls for Urgent Care Management and Considerations for Transfer

• The scapholunate interval is enlarged and the scapholunate angle on the lateral is >60⁰, indicating ligamentous injury to the wrist. This patient should be referred for MRI