What is the role of imaging studies in the diagnosis of lunotriquetral instability?

Updated: Apr 26, 2021
  • Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD  more...
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In stable injuries, routine radiographic findings are normal; stress radiographs may be necessary to detect abnormality in patients with a dynamic instability.

In unstable tears, a VISI deformity is noted, along with a stepoff at the lunotriquetral joint. Wrist arthrography can depict the lunotriquetral tear. Sequential injections of the midcarpal and radiocarpal joints decrease the false-negative rate because some tears may leak in only one direction. If the arthrogram demonstrates a significant leak through the lunotriquetral interval, arthroscopy should be performed to evaluate the extent of the disruption.

Compared with arthrography, wrist arthroscopy is more helpful in determining the location and extent of lunotriquetral ligament disruption. Although MRI is reliable in depicting AVN of the lunate and scaphoid, only in expert hands is it valuable in detecting lunotriquetral tears.

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