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Case A:

30 year old male, wrist pain
Findings? Dx?
MRI Correlation
Final Dx?
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Case B:
29 year old Female, wrist pain

Findings, Dx?
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Case C:
28 year old male, wrist pain
Findings, Dx?

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Case D:
27 year old Female, wrist pain

Findings, Dx?
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Answers
Carpal Dislocations
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Cases 7A-D show the spectrum of lesser-arc injuries:

7A / Grade 1: Scapholunate dissociation ( = rotatory subluxation)
7B / Grade 2: Perilunate dislocation
7C / Grade 3: Midcarpal Dislocation (disruption of lunate/triquetrum)
7D / Grade 4: Lunate dislocation
Typical mechanism is severe dorsiflexion (e.g., fall on outstretched hand)

27A – Scapholunate Dissociation
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  • Initial case (7A) showed only widening (> 2mm) between the scaphoid and the lunate; this is the “Terry Thomas” (aka “David Letterman”) sign
  • The lateral film is not especially helpful for diagnosing this injury
  • These findings represent scapholunate dissociation (rotatory subluxation of the scaphoid), and is the mildest form of this injury
Case B-D
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Case 7B showed a transcaphoid perilunate dislocation; note that the lunate and radius remain normally aligned. This injury is 2-3x more common than a lunate dislocation
  • accompanied by a scaphoid fracture in 75%
Midcarpal and lunate dislocations, as shown in cases 7C and 7D, represent progressively more severe injuries
  • key to diagnosis is the lunate position on the lateral films
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