LT ligament lesion (lunotriquetral instability)

What is an LT ligament lesion?

The lunotriquetral (LT) ligament stabilizes the articulation between the lunate and triquetrum in the proximal carpal row. If this ligament is overstretched, partially torn or completely ruptured, the fine coordination of the carpal bones can be disrupted. The spectrum ranges from a painful ligament strain without instability to manifest instability with patterns of malposition (e.g. VISI - volar intercalated segment instability).

• Degrees of lesion: strain, partial tear, complete tear
• Instability pattern: dynamic (only under load) to static (also detectable at rest)
• Possible long-term consequences: persistent pain, loss of performance, cartilage damage and osteoarthritis

Anatomy and biomechanics of the LT ligament

The carpus consists of two rows of small bones connected by strong ligaments. The LT ligament connects the lunate bone (lunate) with the triquetrum in the proximal row. It has volar (palm side), dorsal (back) and central parts. The volar and dorsal parts in particular contribute significantly to stability.

• Function: Securing the fine movements between the lunate and triquetrum, transferring power during gripping and supporting movements
• Interaction: Interaction with neighboring ligaments (e.g. scapholunate ligament) and the TFCC (triangular fibrocartilage complex)
• Dysregulation: Relevant LT insufficiency can lead to a VISI pattern with increased flexion of the lunate

Causes and risk factors

• Trauma: Falling onto an outstretched hand, twisting, sports accidents
• Overload: Repeated loads in the flexion/extension position, e.g. B. impact sports, strength training, manual work
• Degeneration: Wear of the ligament as a result of aging or existing wrist pathology
• Anatomical factors: carpal bone variations, ligament laxity
• Concomitant injuries: Combination with TFCC lesions or other intercarpal ligament lesions

Typical symptoms

• Ulnar-side wrist pain, often deep
• Increased pain when twisting an ankle, supporting, turning or gripping tightly
• Snapping, clicking, or rubbing in the wrist
• Feeling of instability or “breaking away”
• Loss of strength and rapid fatigue when grasping
• Sometimes swelling or tenderness over the LT gap

Diagnostics: This is how we proceed

Diagnosis is based on history, clinical examination and imaging techniques. The aim is to record the extent of the ligament injury, the stability of the carpus and possible accompanying findings.

Not every LT lesion can be clearly seen on MRI. The combination of clinical experience, suitable functional images and – if necessary – arthroscopy provides the highest diagnostic certainty.

Classification and levels of severity

• By extent: strain (intact ligament), partial tear (partial insufficiency), complete tear (loss of continuity)
• According to stability: dynamic instability (only detectable under load) vs. static instability (also visible at rest)
• Arthroscopic grading: Assessment of ligament quality and intercarpal gap
• Follow-up pattern: VISI configuration in the event of relevant LT insufficiency

Differential diagnoses: What can look similar?

• TFCC lesion (including disc injury, ulnocarpal impaction)
• SL ligament rupture (scapholunate instability)
• ECU tendon problems (subluxation/tendinopathy of the extensor carpi ulnaris tendon)
• Pisotriquetral osteoarthritis or irritation
• Ulnar ganglion
• Carpal tunnel syndrome is more nerve-related - pain is usually localized differently

Conservative therapy: treat gently at first

In the case of strains, partial tears and dynamic instability, conservative treatment is often the first step. The aim is to relieve pain, calm inflammation and functional stabilization.

• Immobilization/splint: short-term in a wrist orthosis (e.g. 2-6 weeks depending on the findings) to provide relief
• Activity adjustment: Avoiding pain-causing stress, ergonomic adjustments in everyday life/work
• Medication options: temporary use of anti-inflammatory painkillers after consultation with a doctor
• Physio/hand therapy: targeted stabilization exercises, proprioception, coordination, mobilization without provocation
• Tape/orthosis during stress: situationally for support in the rehabilitation phase
• Education: Understanding of healing times and gradual build-up of stress

The time until noticeable improvement varies. Early functional, pain-adapted therapy with clear stress levels is important in order to avoid bouts of overload.

Injections and regenerative procedures: when does it make sense?

If irritation persists, targeted infiltration to calm the inflammation can be considered. Regenerative measures are examined individually and classified transparently.

• Cortisone infiltration: may temporarily relieve pain/inflammation; Indication reserved and gentle on the joints, especially in tendon structures.
• Hyaluronic/biological preparations: Use selectively on the wrist; Evidence is inconsistent.
• PRP (Platelet-Rich Plasma): data for wrist ligament healing is still limited; If necessary, option for partial lesions after individual consideration.

Note: Injections do not replace structural stabilization in cases of relevant instability. Decisions are always based on findings, goals and risks.

Surgical options for LT ligament lesions

If there is relevant instability or persistent loss of function despite consistent conservative therapy, or if there are recent, complete tears, a surgical procedure may make sense. The choice of procedure depends on the age of the injury, ligament quality, degree of instability and accompanying findings.

• Arthroscopic debridement/smoothing: for partial tears with mechanical irritation
• Arthroscopically assisted stabilization: temporary wire/screw/pin fixation of the LT joint to support healing
• Direct suture/reinsertion (acute/subacute): if necessary with suture anchors, often combined with temporary transfixation
• Capsulodesis/ligament agumentation: Reinforcement of dorsal/volar stability with limited ligament quality
• Reconstruction with tendon transplant: option for chronic insufficiency without advanced osteoarthritis
• Lunotriquetral partial arthrodesis: joint-preserving partial stiffening as a load line for persistent instability/pain and degenerative changes
• Denervation of the wrist: Pain reduction through selective nerve branches, without eliminating the cause - in individual cases

After surgical procedures, there is a phase of immobilization, followed by gradual hand therapy. The time frame until full weight bearing varies depending on the procedure and healing process.

Rehabilitation, everyday life and sport

• Pain-adapted structure: first mobility and neuromuscular control, then strength and endurance
• Everyday life: ergonomic aids, frequent short breaks, avoiding extreme support positions at the beginning
• Sport: individual level program; contact-intensive or support-heavy sports only after approval and proof of stability
• Occupation: if necessary, gradual reintegration for manual work; Office work possible earlier if there is little pain

Course and prognosis

The prognosis depends on the degree of lesion, initiation of treatment and concomitant factors. Strains and partial injuries often respond to conservative measures. Acute complete tears are more likely to benefit from early stabilization. Untreated instabilities can lead to incorrect loading, cartilage damage and painful sequelae.

• Early detection improves the chances of stable function suitable for everyday use
• Healing times are individual; full resilience can take weeks to months
• Goals: Pain reduction, functional gain, avoidance of long-term consequences - no guarantee

Prevention and self-help

• Load control: gradual training build-up, technique training in sports
• Ergonomics: Wrist-friendly workplace design, alternative gripping techniques
• Stabilization: regular exercises for forearm and hand muscles, proprioception
• React early: if pain persists on the ulnar side, have it clarified promptly

When should I seek medical advice?

• Persistent ulnar wrist pain after a fall or twist
• Recurring snapping/clicking with pain
• Feeling of instability, loss of strength when gripping
• Swelling, pain at rest or pain at night
• Neurological symptoms (e.g. numbness) or acute, severe pain

Your treatment in Hamburg

As an orthopedic specialist practice in Hamburg, we advise and treat hand and wrist complaints with a clear focus on gentle, conservative measures. If necessary, we plan further diagnostics and discuss surgical options transparently.

Practice location: Dorotheenstraße 48, 22301 Hamburg. If you would like an appointment, please use Doctolib or send us an email - we will get back to you as soon as possible.