Incidence of Scapholunate Ligament Dissociation in Patients With Aspiration-Confirmed Gout

Beck, John D.; Deegan, John H.; Riehl, John T.; Klena, Joel C.

doi:10.1016/j.jhsa.2010.08.009

Cited by 16 publications

(15 citation statements)

References 15 publications

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“…Contralateral wrist radiographs might have been helpful in suggesting generalized laxity, as a recent study of 124 contralateral asymptomatic wrists found a scapholunate gap ≥5 mm in 52 % and scapholunate angle ≥60° in 70 %, in accordance with prior studies [17]. Similarly, workup for gout or pseudogout might suggest etiology for scapholunate instability other than the acute injury, as discussed earlier [1, 3].…”

Section: Limitationssupporting

confidence: 78%

“…Thus, we did not find strong support for routinely delaying motion or investigating for possible occult scapholunate ligament injuries, such as with MRI or arthroscopy, especially considering the higher age and low demand in these six patients (group I, average age 71 years). Even when apparent at injury, instability may result not from the acute trauma, but from chronic or accumulated trauma, generalized laxity, crystalline arthropathy, or other age-related changes accompanying osteoarthritis [1, 3, 17, 19, 21, 25]. Indeed, four of the seven cases in group II demonstrated evidence of pre-existing wrist pathology, including chondrocalcinosis and/or arthritic changes (sclerosis and narrowing) of the radioscaphoid, capitolunate, or scaphotrapeziotrapezoid articulations.…”

Section: Discussionmentioning

confidence: 99%

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Scapholunate Instability after Distal Radius Volar Plating

Jones

Everding

Desmarais

et al. 2015

Hand (New York, N,Y.)

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Background Prior to volar locked plating and early motion protocols, ligamentous injuries incidentally associated with distal radius fractures may have been indirectly treated with immobilization. Our goal was to determine the prevalence of scapholunate instability in our population, while identifying those who may have had progression of instability. Methods We retrospectively reviewed 221 distal radius fractures treated with a volar locking plate during a 6-year period. Average patient age was 59 years. Standard posteroanterior and lateral radiographs from the first and last postoperative visits were analyzed for scapholunate instability, using the criteria of scapholunate gap ≥3 mm and scapholunate angle ≥60°. Results Six patients (3 %) met neither or only one criterion for instability at the first postoperative visit and did not have ligament repair and then went on to meet both criteria at the last postoperative visit after an early motion protocol. Seven patients (3 %) met both criteria at the first and last postoperative visits and did not have ligament repair. Five patients (2 %) underwent primary scapholunate ligament repair at the time of distal radius fixation. Conclusions In our representative population, scapholunate instability was uncommon, either from initial injury or possible progression of occult ligament injury, despite early motion without operative treatment of the ligament. Thus, we did not find strong evidence for routinely delaying motion or pursuing further workup. When early radiographs clearly demonstrate acute scapholunate instability, more aggressive treatment may be appropriate for selected patients.

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Section: Limitationssupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Scapholunate Instability after Distal Radius Volar Plating

Jones

Everding

Desmarais

et al. 2015

Hand (New York, N,Y.)

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“…Atraumatic SL interval widening has been reported in asymptomatic individuals [8, 27], and the clinical relevance of this x-ray finding remains uncertain. There were no patients in our study with a known history of gout or pseudogout: two recognized risk factors for SL dissociation [1].…”

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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“…Infection, rheumatoid arthritis, and crystal-induced arthropathies can lead to SL degeneration. SL dissociation can be diagnosed in up to 60% of patients with gouty arthropathy of the wrist 22 and 26% of patients with pseudogout 23 . In these cases, a salvage procedure is recommended because attempts at ligament reconstruction tend to fail.…”

Section: Historymentioning

confidence: 99%