Review Question - QID 217359

Ulnocarpal Abutment Syndrome Differential Lunotriquetral coalition QID: 217359 (OBQ21.40)

QID 217359 (Type "217359" in App Search)

A 31-year-old female presents with left wrist pain after she tripped over a parking block while getting out of her car. In the emergency department, there is dorsal wrist pain that is worse with flexion and extension. Her range of motion is significantly limited. A current radiograph is depicted in Figure A. Which of the following is true regarding this condition?

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There is a predisposition for scaphoid fractures given her anatomy

110/1225

This is a uncommon variant without any significant risk for sequelae

56%

687/1225

Surgical treatment is recommended to restore normal range of motion

61/1225

Abnormal TFCC anatomy is associated with this condition

27%

333/1225

There is a high association with inflammatory arthritis

27/1225

Select Answer to see Preferred Response

The patient has a lunotriquetral coalition which is an uncommon normal variant without any risk for sequelae.

Lunotriquetral coalition is a relatively uncommon variant that is most often seen in patients of African descent. This is usually an incidental finding and rarely the culprit in wrist pain. However, patients that have persistent wrist pain in the setting of a coalition can be treated with arthrodesis. Carpal coalitions have been associated with several syndromes including arthrogryposis, diastrophic dwarfism, Turner syndrome, and Ellis-van Creveld syndrome.

Ozyurek et al. reported a case of ulnar-sided wrist pain after trivial trauma in a patient with a lunotriquetral coalition. The author reported the patient's pain resolved within 5 days following analgesics and bandaging. They concluded a lunotriquetral coalition is often an incidental finding in the asymptomatic patient.

Mespreuve et al. presented two cases of lunotriquetral coalition consisting of a fibrocartilaginous union. They described acute onset ulnar-sided wrist pain with an MRI demonstrating pseudoarthrosis and associated bone marrow edema and cysts. They stated a formal lunotriquetral fusion can be performed in patients that are persistently symptomatic.

Kennedy et al. reported a case of a 17-year-old martial artist that presented with a distal radius fracture with incidental findings of lunotriquetral and capitotrapezoid coalitions. The patient healed the distal radius fracture without issues and an MRI of the wrist revealed normal TFCC ligamentous anatomy. The authors concluded carpal coalitions are often incidental findings with a higher predilection with familial inheritance patterns and a higher incidence in Africans.

Figure A is an AP radiograph of the left wrist depicting a lunotriquetral coalition.

Incorrect Answers:
Answer 1: The presence of a lunotriquetral coalition does not predispose the patient to scaphoid fractures.
Answer 3: Lunotriquetral coalition take-down and soft-tissue interposition is not recommended in order to improve range of motion.
Answer 4: Patients with a lunotriquetral coalition do not appear to have abnormal TFCC anatomy.
Answer 5: There is no known association between lunotriquetral coalition and inflammatory arthritis.