Wrist Instability (Lunotriquetral Ligament Injuries): Treatment Options

Wrist Instability (Lunotriquetral Ligament Injuries): Treatment Options

This video will provide an overview of treatment options for lunotriquetral, or L T, joint injuries. The LT joint lies between the lunate and triquetrum. The primary ligament that connects these 2 bones together is called the LT ligament.

Often, injury to this ligament occurs alongside injury to other nearby ligaments in the wrist. While injuries to this joint are uncommon, they remain the second most common injury in the wrist that can lead to instability. These injuries, if unrecognized, can lead to impairment in daily activities and the development of arthritis.

LT injuries can be treated in a variety of ways, which are dependent on several factors. First, a health care provider will consider specific patient factors like age, physical demands, and severity of pain. Second, consideration will be made to the severity of the injury and the other possible injuries that may accompany the LT joint disruption. And third, the timing of when the injury occurred will be factored into the treatment plan.

After careful evaluation, a health care provider will determine if the injury can be treated with or without surgery. Treatment without surgery is generally considered first for these injuries, especially those without wrist instability. Treatment in this fashion would include a cast or splint for several weeks to stabilize the injury while it heals. In addition, anti-inflammatory medications or steroid injections may be trialed.

If pain persists despite treatment without surgery, or the surgeon determines treatment with surgery is needed based on the severity of injury and the patient's needs, multiple surgical options can be considered. Operative choices for treatment of LT joint instability are highly variable, with little consensus on the best choice. These options may include use of arthroscopy, in which a small camera is used along with instruments to remove damaged tissue, known as a debridement. This is typically chosen if there is no instability in the joint.

If instability is present, other techniques are often used, such as placing temporary wires to hold the joint in place while it heals. Other surgical options may be preferred, such as repair of the ligament with the use of internal support sutures, reconstruction of the ligament with tendon grafts, or fusion of the joint. Following any procedure, a patient may be placed in a protective splint temporarily, and therapy may be ordered to assist in recovery.