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

 

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