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Carpal ligament injuries

Last updated: April 22, 2025

Summarytoggle arrow icon

Carpal ligament injuries are typically caused by forceful wrist hyperextension (e.g., fall on an outstretched hand). These injuries follow a progressive pattern; the scapholunate ligament is affected first and causes scapholunate dissociation. More severe trauma can disrupt the lunocapitate, lunotriquetral, and lunoradial ligaments, causing perilunate, triquetral, or lunate dislocations. Symptoms of carpal ligament injuries include wrist swelling and pain, restricted range of motion, and point tenderness at the dorsal scapholunate interval. Symptoms of median nerve injury may also occur. Diagnosis is based on features of carpal malalignment on imaging. Scapholunate dissociation is managed with immobilization and orthopedics follow-up within one week. Carpal dislocations require emergency reduction and stabilization followed by definitive treatment with open reduction and internal fixation. Carpal ligament injuries can result in carpal instability, particularly if the ligamentous support is significantly compromised. Other complications include chronic carpal instability, degenerative arthritis, dorsal intercalated segment instability (DISI), and volar intercalated segment instability (VISI).

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Etiologytoggle arrow icon

  • Trauma (most common)
    • Typically caused by sudden impact to the wrist in hyperextension (e.g., fall on an outstretched hand) [1][2][3]
    • Can also be caused by repetitive strain injury [4]
  • Other possible underlying causes (rare) [4]
    • Infectious or inflammatory arthritis
    • Congenital anomalies
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Pathophysiologytoggle arrow icon

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Clinical featurestoggle arrow icon

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Diagnosistoggle arrow icon

Approach [3][6][8]

Imaging [3][6][8]

Scapholunate dissociation [3][9]

Perilunate dislocation [3][9]

Midcarpal dislocation [3][9]

Lunate dislocation [3][9]

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Managementtoggle arrow icon

Initial management [1][6]

Surgery [1][11][12]

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Complicationstoggle arrow icon

General complications

Dorsal intercalated segment instability (DISI) [2][3]

  • Definition: carpal instability caused by scapholunate ligament disruption, where the scaphoid flexes forward and the lunate is pulled dorsally by the intact lunotriquetral ligament. [2][3][11]
  • Diagnosis
    • Abnormal scapholunate angle on x-ray due to excessive scaphoid flexion and lunate (and often triquetrum) extension [3]
    • A scapholunate gap > 4mm and lunate extension > 10° suggest DISI. [15]
  • Management [3]
    • Outpatient orthopedic referral for surgical repair is appropriate for most cases.
    • Urgent evaluation is indicated if there is instability post-trauma, with dislocation and/or neurovascular compromise.

In DISI, scapholunate ligament disruption leads to dorsal rotation of the lunate and excessive volar rotation of the scaphoid. [2][3]

Volar intercalated segment instability (VISI) [2][3][7]

  • Definition: abnormal volar rotation of the lunate due to lunotriquetral ligament injury, causing the lunate to follow the scaphoid into flexion while the scapholunate ligament remains intact [7][12]
  • Diagnosis
    • Excessive volar rotation of the lunate relative to the capitate on x-ray [3]
    • A scapholunate angle < 30° in the presence of lunotriquetral diastasis supports a diagnosis of VISI. [15]
  • Management [3][7]
    • Outpatient orthopedic referral for surgical repair is appropriate for most cases.
    • Urgent evaluation is indicated if there is instability post-trauma, with dislocation and/or neurovascular compromise.

In VISI, lunotriquetral ligament disruption results in excessive volar flexion of the lunate relative to the capitate on x-ray. [7]

We list the most important complications. The selection is not exhaustive.

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