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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