Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute/chronic radial-sided wrist pain following a fall onto an outstretched hand (FOOSH). Reports localized tenderness over the scapholunate interval, exacerbated by wrist extension and radial deviation. Associated symptoms include subjective weakness in grip strength, a sensation of "clunking" or instability during rotational maneuvers, and intermittent swelling. No history of distal radius fracture or prior wrist surgery.
Clinical Examination Findings
Physical examination reveals localized tenderness at the scapholunate (SL) interval (Watson's shift test positive). Range of motion is limited by pain in extension. Grip strength is diminished compared to the contralateral side. Neurovascular status is intact distally. Radiographic evaluation demonstrates increased scapholunate gap (>3mm) and/or "Terry Thomas sign" on AP view; lateral view shows scapholunate angle >60 degrees, suggestive of DISI deformity.
Treatment Protocol
Initial management includes immobilization in a thumb spica splint or short arm cast for 4-6 weeks to allow for ligamentous healing. NSAIDs for pain and inflammation control. If chronic or symptomatic instability persists, surgical intervention is indicated, ranging from ligament repair/reconstruction (e.g., Brunelli procedure) to salvage procedures such as partial wrist arthrodesis or proximal row carpectomy depending on the presence of secondary degenerative changes.