Arthroscopic Management of Scapholunate Dissociation

Current Concepts in MR and CT Arthrography

“…1,30,36 Symptomatic dysfunction that results from the loss of the mechanical linkage between the scaphoid and the lunate (with or without carpal malalignment) has been termed SL dissociation. 1,30,36 Symptomatic dysfunction that results from the loss of the mechanical linkage between the scaphoid and the lunate (with or without carpal malalignment) has been termed SL dissociation.…”

“…The dorsal SL ligament, which plays the key role in SL instability, is located along the deep surface of the dorsal wrist capsule and connects the dorsal aspects of the scaphoid and lunate. 30,36 This can be seen primarily or acutely in the setting of hyperextension stress or secondarily due to progressive stretching of these structures. With a disrupted SL ligament, there is increased motion between the two bones that generates shear stress, thereby resulting in synovitis and pain (predynamic and dynamic clinical forms of SL dissociation).…”

“…1,2,5,30 Although isolated SL ligament disruption may not result in immediate and complete diastasis or radiographic malalignment, such disruption is a prerequisite for the development of SL dissociation. 30,36 Over time, there is subsequent development of degenerative arthritis. 30 Permanent carpal malalignment is not seen unless there is concomitant disruption of the secondary stabilizers of the scaphoid such as the volar distal scaphotrapezial dorsal intercarpal and SL ligaments (►Fig.…”

“…30 Permanent carpal malalignment is not seen unless there is concomitant disruption of the secondary stabilizers of the scaphoid such as the volar distal scaphotrapezial dorsal intercarpal and SL ligaments (►Fig. 30,36 Initially, suspected SL injuries are evaluated with radiographs. 30,36 This can be seen primarily or acutely in the setting of hyperextension stress or secondarily due to progressive stretching of these structures.…”

“…15). 30,36 Coronal and axial MR images are best for direct evaluation of the SL ligament. Complete disruption of the ligaments between the scaphoid and lunate results in proximal CID and DISI.…”