Differentials
Wrist strain
SIGNS / SYMPTOMS
No deformity.
INVESTIGATIONS
No evidence of fracture on radiographs.
Ligamentous carpal injury
SIGNS / SYMPTOMS
The most common injury is scapholunate ligament tear with widening of the scapholunate interval.
Wrist pain with no signs of a fracture.
Pain with palpation on dorsum of wrist at the scapholunate interval.
Positive Watson shift test.
INVESTIGATIONS
No evidence of distal radius fracture on radiographs (radial/ulnar deviation and a clenched fist view). Images of the contralateral wrist can be performed for comparison.
Wrist cineradiography has a sensitivity of 90%, a specificity of 97%, and a diagnostic accuracy of 0.93 in detecting scapholunate interval.
Radiography has a sensitivity of 81%, a specificity of 80%, and a diagnostic accuracy of 0.81.
Cineradiography has a high diagnostic value for diagnosing scapholunate intervals.[41]
Triangular fibrocartilage complex (TFCC) tear
SIGNS / SYMPTOMS
Ulnar-sided wrist pain.
Pain with ulnar deviation, more so than radial.
Pain with manipulation of distal ulna dorsal/volar.
Positive fovea sign.
INVESTIGATIONS
Very difficult to assess acutely.
A radiologic widening of the distal radioulnar joint may be a sign of a ligament injury to the TFCC.
MRI arthrogram of the wrist is the best way to assess with imaging. Another option would be wrist arthroscopy.
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