Symptomatic fibrous lunato-triquetral coalition

Abstract

In general, carpal coalitions are considered to be asymptomatic. Incomplete separated joints and associated changes similar to osteoarthritis and pseudoarthrosis are known as possible causes of wrist pain. We present the clinical history, plain-film, and MR imaging findings of two patients with symptomatic fibrous lunato-triquetral coalition. Conventional films disclosed a narrowed space between the lunate and triquetral bone with cysts and sclerosis similar to pseudoarthrosis. Magnetic resonance imaging showed bone marrow edema adjacent to the incomplete separated lunato-triquetral joint and Gd-DTPA enhancing fibrovascular tissue in the synovium and subarticular cysts, explaining the pain over the ulnar-sided wrist. Patients with congenital lunato-triquetral coalition may poorly tolerate stress loading or trauma, resulting in a symptomatic state similar to degenerative arthritis or pseudoarthrosis, which is demonstrated by enhanced MR imaging.

Lunotriquetral coalition, a normal variant that may rarely cause ulnar sided wrist pain

“…10), trauma, surgery (Fig. 11), drug intake during pregnancy or a metaplastic conversion of intra-articular structures (fibrous tissue, ligaments or cartilage) (14).…”

Radiographically Occult Symptomatic Lunotriquetral Coalition in a Child

“…Carpal coalitions occur secondary to a failure of segmentation of the common cartilage precursor of the carpal bones [1][2][3]. Normally, apoptosis of certain cells within the cartilaginous carpal precursor of the lunate and triquetrum creates a cleft between the lunate and triquetrum by the tenth week of intrauterine life [7].…”

“…Patients with complete osseous union at a carpal coalition are asymptomatic and this is typically found incidentally at imaging for other causes of pain or after a trauma [2]. However, there are several case reports and small case series of symptomatic non-osseous carpal coalitions [2][3][4][5][6][7]. We present a case of a 13-year-old boy with a symptomatic non-osseous lunotriquetral coalition which was undetected on initial radiographs but diagnosed on a subsequent wrist magnetic resonance imaging (MRI).…”

Fracture of the scapholunate coalition

“…While its incidence is 0.1% in whites, it rises up to 9.5% in some societies living in the West Africa. 1,2 There are two types, which are osseous and non-osseous. 3 The carpal bones that form coalition in the osseous type create a single block bone by combining with each other.…”