Comparison of Radiographic Stress Views for Scapholunate Dynamic Instability in a Cadaver Model

Lee, Steve K.; Desai, Healthy; Silver, Benjamin; Dhaliwal, Gurpreet; Paksima, Nader

doi:10.1016/j.jhsa.2011.05.009

Cited by 80 publications

(77 citation statements)

References 70 publications

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“…Lee et al [14] performed a cadaveric experiment to assess eight stress x-ray images and concluded that the PA clenched pencil view consistently showed the widest SL gap. All ligaments surrounding the scaphoid were sectioned in their study.…”

Section: Discussionmentioning

confidence: 99%

Comparisons of Three Radiographic Views in Assessing for Scapholunate Instability

Patel

Kalainov

Chilelli

et al. 2014

Hand (New York, N,Y.)

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Background Multiple wrist x-ray images have been described to assess for scapholunate (SL) instability. Some views may be redundant. The purpose of this study was to compare three plain x-ray views in identifying a traumatic diastasis of the SL interval. Methods Nineteen patients (19 wrists) with a positive scaphoid shift test and surgically confirmed SL ligament damage were identified. There were 15 males and 4 females with a mean age of 39 years. Pre-operative x-rays were reviewed, including posteroanterior (PA) neutral and PA ulnar deviation views of the injured wrist, and PA clenched fist views of the injured and uninjured wrists. Dynamic SL instability was defined by an SL mid-interval gap of <3 mm and static SL instability by a gap of ≥3 mm in the PA neutral views. The mid-interval measurements were compared between x-ray images. Results There were 10 dynamic and 9 static SL instability cases. The PA ulnar deviation and the PA clenched fist views showed significantly greater SL gaps in comparison to the PA neutral views in dynamic but not static SL instability cases. In both categories of instability, there was no significant difference in the SL gaps between the two stress images. The PA clenched fist view of the uninjured wrist revealed SL gapping of >3 mm in 50% of patients but with generally greater gapping in the clenched fist view of the injured wrist. Conclusions The PA ulnar deviation and clenched fist stress views were equally effective in showing a dynamic SL diastasis following wrist injury. Neither view was more effective than a neutral PA view in diagnosing static SL instability.

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Section: Discussionmentioning

confidence: 99%

Comparisons of Three Radiographic Views in Assessing for Scapholunate Instability

Patel

Kalainov

Chilelli

et al. 2014

Hand (New York, N,Y.)

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show abstract

“…As obtaining these stress views can cause pain for the patient and patient effort is required, caution must be used when evaluating these studies. In a cadaveric model, the PA clenched pencil view, which allows viewing of both wrists simultaneously, was the most reproducible and consistently showed the widest SL gaps [5]. Contralateral wrist comparison radiographs are strongly recommended as some SL widening may be physiologic rather than pathologic.…”

Section: Diagnosismentioning

confidence: 94%

“…A 20°t angential PA view as described by Moneim is also recommended as it allows direct viewing of the SL interval and does not require painful contraction or positioning by the patient [16]. Multiple stress views have been proposed including: PA clenched fist-neutral, PA clenched fist-radial deviation, PA clenched fist-ulnar deviation, PA finger traction-pronation, PA thumb traction, anteroposterior (AP) clenched fist-neutral, AP clenched fist-radial deviation, PA clenched pencil, and AP clenched fist-ulnar deviation (UD) [5]. As obtaining these stress views can cause pain for the patient and patient effort is required, caution must be used when evaluating these studies.…”

Section: Diagnosismentioning

confidence: 99%

“…Static instability is noted when a widened scapholunate interval and a dorsiflexion intercalated segment instability (DISI) pattern are observed on neutral, non-stress radiographs. Static scapholunate dissociation correlates with a more involved injury to the secondary stabilizing extrinsic ligaments, in addition to the SL ligament itself [4,5].…”

Section: Diagnosismentioning

confidence: 99%

“…There is an extensive extrinsic ligamentous complex that consists of volar and dorsal radiocarpal and ulnocarpal ligaments that provides additional stability to the proximal row. Injuries to the wrist vary in severity by the degree and number of stabilizing ligaments disrupted [4,5].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Scapholunate and perilunate injuries in the athlete

Morrell

Moyer

Quinlan

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of the review Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries. Recent findings Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season. The treatment of static scapholunate ligament injury remains controversial. Newer SL reconstructive techniques that aim to restore scapholunate function without compromising wrist mobility as much as tenodesis procedures show promise in athlete patients. Summary Acute injuries to the scapholunate ligament are best treated aggressively in order to prevent the sequelae of wrist arthritis associated with long-standing ligamentous injury. Acute repair is favored. Reconstructive surgical procedures to manage chronic scapholunate injury remain inferior to acute repair. The treatment of lunotriquetral ligament injuries is not well defined.

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Hand examination and investigations

Coert

Hoogvliet

Rinkel

2015

Plastic and Reconstructive Surgery

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CHapter 48The medical student adage of 'look, feel and move' applies to hand examination at all clinical levels. Having been put in harm's way more than any other part of the body, this extension of our mental will into the external world doubles up as a tactile organ as well. A thorough knowledge of its anatomy and biomechanical principles assists the clinician in narrowing down the pathology. Recognition of patterns of pathology and injury are as important in examining the hands as they are in any other form of clinical examination.

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Comparison of Radiographic Stress Views for Scapholunate Dynamic Instability in a Cadaver Model

Cited by 80 publications

References 70 publications

Comparisons of Three Radiographic Views in Assessing for Scapholunate Instability

Comparisons of Three Radiographic Views in Assessing for Scapholunate Instability

Scapholunate and perilunate injuries in the athlete

Hand examination and investigations

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