Hand Surgery Source

LT Ligament (TENDERNESS)

Test, Exam and Signs

Description

  • The lunotriquetral (LT) ligament tenderness test can help to diagnose a LT ligament tear, in the presence of wrist discomfort and typical radiographs.1

Pathophysiology

  • A LT ligament tear may be caused by an injury, usually a fall on an outstretched hand (FOOSH).2
  • Treatment will vary, depending on whether the injury is a partially stable ligament tear or a more extensive perilunate instability.3
  • If a LT ligament tear is severe and untreated, it may develop into osteoarthritis.

Instructions

  1. Obtain an accurate and complete patient history. Ask the patient to rate on a scale from 1 to 10 how much pain s/he usually experiences in the affected hand and wrist. Determine how long this pain has continued.3
  2. Palpate the wrist in the area of the LT ligament and check for crepitus.
  3. Observe whether the patient experiences tenderness with pressure at the LT ligament.
  4. Examine the contralateral hand and wrist.

Variations

  • Do not use other patients’ reactions as a comparison, because other patients may have different perceptions of similar tenderness and/or pain.

Related Signs and Tests

  • LT ballottement test4
  • Range of motion (ROM), active
  • Grip strength2
  • Shuck test
  • Shear test1
  • Magnetic resonance imaging (MRI)4

Diagnostic Performance Characteristics

  • To improve reliability, MRI may be helpful. For LT ligament tears, the sensitivity of MRI is 30–50%, and the specificity is 4–97%.4,5
  • MRI may not be reliable in diagnosing partial ligament tears.1
Definition of Positive Result
  • A positive result occurs when the patient experiences tenderness at the LT ligament with pressure. 
Definition of Negative Result
  • A negative result occurs when the patient does not experience tenderness at the LT ligament with pressure. 
Comments and Pearls
  • Non-operative treatments include immobilization and cortisone injections.2
  • Operative treatment for a LT ligament tear depends on the degree of stability. Arthroscopic debridement may be used for stable injuries. For unstable injuries, options include reconstruction or arthrodesis.2
References
  1. Kleinman WB. Physical Examination of the Wrist: Useful Provocative Maneuvers. J Hand Surg Am 2015;40(7):1486-1500. PMID: 26043802
  2. Butterfield WL, Joshi AB, Lichtman D. Lunotriquetral Injuries. J Hand Surg Am 2002;2(4):195-203.
  3. van de Grift TC, Ritt MJ. Management of lunotriquetral instability: a review of the literature. J Hand Surg Eur 2016;41(1):72-85. PMID: 26188693
  4. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012
  5. Moser T, Dosch JC, Moussaoui A, et al. Wrist ligament tears: evaluation of MRI and combined MDCT and MR arthrography. AJR Am J Roentgenol 2007;188:278-86. PMID: 17449771