Arthroscopic Resection of Lunotriquetral Coalition

Abstract

Carpal coalition is a rare condition caused by a failure in the process of apoptosis. It is often incidentally diagnosed and seldomly symptomatic. The lunotriquetral joint is the most commonly affected joint, accounting for 90% of carpal coalitions. Minnaar classified the lunotriquetral coalitions into 4 types based on their type, extent, and associated abnormalities. Accurately classifying the coalition requires advanced imaging, and we show an example that includes 2-dimensional and 4-dimensional computed tomography and magnetic resonance imaging. Management of carpal coalitions include nonoperative and operative management. Splinting, anti-inflammatory drugs, hand therapy, activity modification, and steroid injections are all examples of nonoperative management. Operative management of coalitions in the carpus has historically been an arthrodesis whereas in the tarsal bones the gold standard is resection. Arthrodesis has a high complication rate and reduces wrist range of motion, whereas resection retains range of motion and allows the patient to return to activity sooner. We present 2 techniques of treating symptomatic carpal lunotriquetral coalition with arthroscopic resection.