Scapholunate Dissociation
The spacing between all carpal bones should be 1-2 mm, look for the "Terry Thomas" sign to diagnosis scapholunate dissociation. Here's a quick summary.
• Due to injury to the scapholunate interosseous ligament
• The spacing between all carpal bones should be 1-2 mm
• Widened scapholunate space >3 mm on PA view ("Terry Thomas sign"), worsens with clenched fist
• Mechanism: Fall onto outstretched hand
• Exam: Tenderness to anatomic snuff box, pain with wrist extension
• Possible associated injuries: distal radius fracture, scaphoid fracture, perilunate or lunate dislocation
• ED Management: Pain control, immobilize
• Splint: Thumb spica
• Ortho consult: No (unless associated fracture or dislocation)
• Disposition: Discharge, follow-up with orthopedics in 1 week
MH/CCF/CWRU EM Res @MetroHealth_EM
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