Challenge of the Week / Hand & Wrist / 07.09.2021

A 37-year-old female patient who is a dancer presents with 1 year of ulnar-sided wrist pain. The patient was previously diagnosed with an injury to her lunotriquetral ligament that was confirmed on magnetic resonance imaging. She had transient relief with a corticosteroid injection and a 6-week course of immobilization. Unfortunately, she remains symptomatic and cannot perform her job at the level that is required. Which of the following is the appropriate treatment option for the patient at this time?

    • Lunotriquetral ligament reconstruction
    • Lunotriquetral reconstruction should be considered only after instability is confirmed arthroscopically.

 

    • Proximal row carpectomy
    • Carpectomy is a salvage procedure and should only be performed after other options are exhausted.

 

    • Wrist arthroscopy and debridement of the lunotriquetral interval
    • The patient has failed a course of nonoperative treatment, so arthroscopy with debridement is appropriate. If there is instability noted during arthroscopy, further procedures may be necessary, but this is the appropriate next step.

 

    • Total wrist arthrodesis
    • Wrist arthrodesis is a salvage procedure and should only be performed after other options are exhausted.

     

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