Lunotriquetral coalition
Lunotriquetral coalition is the most common type of carpal coalition and represents a congenital fusion of the lunate and triquetral bones of the carpus.
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Epidemiology
Lunotriquetral coalition is the most common type of carpal coalition with a prevalence of 0.1%. It is more common in females (F:M = 2:1) and African Americans.
Clinical presentation
Whilst osseous coalitions of the lunate and the triquetrum are known to be asymptomatic, fibrocartilaginous lunotriquetral coalitions can present as an uncommon cause of ulnar-sided wrist pain often due to the pseudarthrosis or a post-traumatic disruption 3,8.
Pathology
- coalition may be fibrous, cartilaginous or osseous 5
- commonly bilateral 4
Carpal coalitions can follow an autosomal dominant route of inheritance
Classification
de Villiers classified lunotriquetral coalition into four types 6:
- incomplete (or fibrocartilaginous) fusion - resembles a pseudoarthrosis
- incomplete osseous fusion
- complete osseous fusion
- complete osseous fusion with other carpal abnormalities
Radiographic features
Plain radiograph
- coalition of the lunate and triquetrum
- may be accompanied by a widened scapholunate interval 4
Treatment and prognosis
Most commonly an incidental finding. May occasionally be the cause of chronic wrist pain (especially in types 1 and 2 6) and, of course, can be fractured.
Related Radiopaedia articles
Anatomy: Upper limb
-
skeleton of the upper limb
- clavicle
- scapula
- humerus
- radius
- ulna
- carpal bones (mnemonic)
- metacarpals
- phalanges
- accessory ossicles of the upper limb
- accessory ossicles of the shoulder
- accessory ossicles of the elbow
-
accessory ossicles of the wrist (mnemonic)
- os centrale carpi
- os epilunate
- os styloideum
- os hamuli proprium
- lunula
- os triangulare
- trapezium secondarium
- os paratrapezium
- os radiostyloideum (persistent radial styloid)
- joints of the upper limb
-
pectoral girdle
-
shoulder joint
- articulations
- associated structures
- joint capsule
- bursae
- ligaments
-
movements
- scapulothoracic joint
- glenohumeral joint
- arm flexion
- arm extension
- arm abduction
- arm adduction
- arm internal rotation (medial rotation)
- arm external rotation (lateral rotation)
- circumduction
- blood supply - scapular anastomosis
- ossification centers
-
shoulder joint
-
elbow joint
- proximal radioulnar joint
- ligaments
- associated structures
- movements
- alignment
- blood supply - elbow anastomosis
- development
-
wrist joint
- articulations
-
ligaments
- intrinsic ligaments
- extrinsic ligaments
- radioscaphoid ligament
- dorsal intercarpal ligament
- dorsal radiotriquetral ligament
- dorsal radioulnar ligament
- volar radioulnar ligament
- radioscaphocapitate ligament
- long radiolunate ligament
- Vickers ligament
- short radiolunate ligament
- ulnolunate ligament
- ulnotriquetral ligament
- ulnocapitate ligament
- ulnar collateral ligament
- associated structures
- extensor retinaculum
- flexor retinaculum
- joint capsule
- movements
- alignment
- ossification centers
-
hand joints
- articulations
- carpometacarpal joint
-
metacarpophalangeal joints
- palmar ligament (plate)
- collateral ligament
-
interphalangeal joints
- palmar ligament (plate)
- collateral ligament
- movements
- ossification centers
- articulations
-
pectoral girdle
- spaces of the upper limb
- muscles of the upper limb
- shoulder girdle
- anterior compartment of the arm
- posterior compartment of the arm
- anterior compartment of the forearm
-
posterior compartment of the forearm (extensors)
- superficial
- deep
- hand (mnemonic)
- accessory muscles
- blood supply to the upper limb
-
arteries
- subclavian artery (mnemonic)
- axillary artery
- brachial artery (proximal portion)
- ulnar artery
- radial artery
- veins
-
arteries
- innervation of the upper limb
- intercostobrachial nerve
-
brachial plexus (mnemonic)
- branches from the roots
- branches from the trunks
- branches from the cords
- lateral cord
- posterior cord
- medial cord
- terminal branches
- lymphatic drainage of the upper limb
