0:01

Case three,

0:02

left wrist pain evaluated for ulnar impaction or cause of ulnar sided wrist

0:06

pain.

0:07

And this was the case of lunar triquetral intraosseous

0:12

ligamentous failure. So on this case, okay,

0:16

we can see right off the bat we have this offset, okay? This, uh,

0:21

vertical offset between the, the, uh,

0:25

proximal aspects articular surface of the lunate and triquetral,

0:30

okay? And what we also see is that that ligament is torn. And again, uh, just,

0:35

uh, just to reemphasize, okay?

0:37

It's the lar component of the lunar choal interosseous ligament,

0:42

that's more important, okay? As opposed to the SLIL, where,

0:46

where the dorsal component was, was the most important, okay? And as this,

0:51

and as this ligament fails, the lunar choal intraosseous ligament fails.

0:55

That is okay. The tendency for the lunate with this,

1:00

uh, injury is going to be to, uh,

1:03

ly tilt or VC defor me, PI or sorry, VISI.

1:08

Okay? And we can start to, um, see some of that.

1:12

And right here as the,

1:17

the lunate starts to, uh, lar bolly tilt on itself, okay?

1:22

As, uh, typical some, uh, as usually a,

1:26

assuming the scap lunate intraocular ligament is in tap,

1:29

the lunate is gonna wanna spin a, uh,

1:31

spin and flex with the scape void as the wrist is

1:36

loaded. And that's why you get that VC deformity,

1:40

assuming you have the LTIL injury. Now,

1:43

the secondary stabilizers that I try to look for, the important ones,

1:48

four lunar tri interosseous ligament injuries are going to be

1:52

three of them. Okay? Last I studied, they're,

1:56

they're going to be the long radial luno TriCal ligament, okay?

2:02

And that's gonna be on the palmar side, okay?

2:06

But it's basically gonna be a ligament that runs, uh, from the, uh,

2:12

radius over to the lunate, and sometimes sending slips over to the triquetrum.

2:17

Okay?

2:18

The other one is going to be the al triquetral ligament.

2:22

And this ligament, okay, actually, uh,

2:26

is a short ligament that attaches between the, uh,

2:30

palmer,

2:31

proximal palmar aspect of the triquetrum and inserts

2:36

upon the, uh, triangular fibrocartilage complex.

2:40

And if you actually tear this, for those that are interested in, um,

2:44

Palmer classifications in the acute injuries, this would qualify as a Palmer,

2:49

uh, one C injury in the acute setting, one C as in cat,

2:54

okay? The other stabilizer,

2:57

important stabilizer for this is gonna be the dorsal radiocarpal

3:02

ligament, okay? And that's on the dorsal side, hence dorsal. Okay?

3:07

But that's gonna be a little bit more proximal to the dorsal

3:11

intercarpal ligament that I was speaking about earlier.

3:14

And that's probably this ligament right here.

3:16

This is probably the dorsal radial carpal ligament. Okay?

3:21

And then this is the dorsal intercarpal ligament.

3:25

So as you're studying, okay, and just to round out, okay, and,

3:30

and I apologize if, if you look at this enough times, uh,

3:34

as I have, it starts to make a little bit sense. But, uh, again,

3:38

in all honestly, full disclosure, I,

3:40

I always have to review this every once in a while, okay?

3:44

But I've distilled it down to the best of my ability, at least,

3:47

and to my knowledge, about a dozen or so ligaments, okay?

3:52

The most important ones obviously are gonna be the SLIL, okay?

3:56

That's the most important, followed by the LTIL.

4:00

And those are gonna be the intrinsic intracapsular ligaments are gonna be the

4:04

most important, particularly for carpal instability, dissociative, okay?

4:10

Followed by some extrinsic ligaments. Okay? Now, the extrinsic ligaments,

4:15

you have the l um,

4:18

the long radial lunate TriCal ligament,

4:23

which I showed y'all, okay? Runs,

4:28

sorry, from, it's probably

4:34

this ligament right here. Okay?

4:37

Then you have the ulnolunate and the TriCal ligaments right

4:41

here, okay? Which keep the, the proximal Carole,

4:45

particularly that lunate, okay? From Palmer Lee, subluxing and dislocating.

4:50

And again, that's between those bones and the distal aspect of the triangle.

4:54

Fiber, cartilage, okay? Then you have the,

5:00

uh,

5:01

v what I like to call also the other extrinsic or v-shaped ligaments, okay?

5:06

And those can be divided into proximal and distal. Okay?

5:09

And we kind of talked about that, those earlier,

5:12

and those can be the radio scap capitate ligament,

5:18

the STT ligament. Okay?

5:21

And then you also have AS scfo capitate ligament,

5:25

and then you have a tricho hamo capitate ligament. Okay?

5:29

So that's another four right there on top of the other five that artery

5:34

gave you. And then finally, on the dorsal side,

5:38

you have the dorsal inter collated ligament,

5:41

or the DIC for short and the dorsal radiocarpal ligament,

5:45

or DRCL for short. And that's on the dorsal side.

5:49

And to point those out, again,

5:52

that's the d the dorsal carpal, uh, sorry, the

5:57

Dorsal radiocarpal ligament.

5:59

And then this is the DIC or the dorsal intercarpal ligament. So that,

6:04

in a nutshell, is the best of my ability, uh,

6:08

to distill carpal basic carp or simplify carpal instability as,

6:12

as I know it now.