Volar intercalated segmental instability (VISI)

Case contributed by Dr Fabien Ho

Presentation

Intermittent chronic wrist pain. Manual worker. Suspicion of fatigue fracture.

Patient Data

Age: 35 years
Gender: Male

No bone marrow edema.
Bone misalignment: lunate does not align with radius and shows palmar (volar) tilt. Capitate is displaced anteriorly in relation to radius.
Radiocarpal and midcarpal joint effusion.
Midcarpal degenerative changes with lunocapitate chrondropathy.
A study of the intrinsic and extrinsic ligaments is not achievable on these sequences.
Muscles and tendons all appear normal.

The scaphoid and lunate are partially juxtaposed on the triquetral and the second carpal row, thus the arcs of Gilula are incompletely visualized on frontal view.
No scapholunate diastasis upon ulnar deviation.

Intrinsic ligaments: rupture of the lunotriquetral ligament, explaining the VISI pattern. Scapholunate ligament is intact.
Extrinsic ligaments: distension of the articular capsule dorsally is highly suspicious for associated dorsal radiolunotriquetral ligament injury.

Midcarpal joint impingement and chrondropathy.

Case Discussion

Misalignment of the radius-lunate-capitate axis is suspicious for carpal instability.
This was suspected on MR coronal and sagittal views, wherefore and patient had a dynamic X ray study done for confirmation.
Intrinsic ligamentous injuries of the wrist can be visualized with CT arthrography, as in this case.

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Case information

rID: 61326
Published: 28th Jun 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: CHU de Bordeaux

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