Presentation
Work-up for severe, bilateral wrist pain. There is a negative trauma history. There is an unremarkable past medical history.
Patient Data
There is bilateral scapholunate diastasis, radioscaphoid and capitolunate osteoarthritis.
There is an incidental left 1st metacarpal phalangeal subluxation.
There is bilateral proximal capitate migration and disruption of the distal carpal arc.
A left scaphoid fracture is presently not excluded.
Dorsal intercalated segment instability (DISI) is also presently not excluded on the plain film imaging.
Case Discussion
Features suggestive of bilateral scapholunate advanced collapse (SLAC). This appears as stage III on the right and likely stage II on the left.
CT imaging can be considered to assess for carpal fractures (especially the left scaphoid bone ) and confirm/ exclude a possible associated dorsal intercalated segment instability (DISI).
Calcium pyrophosphate dihydrate deposition disease (CPPD) screening has been recommended.
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