Assessment of scapholunate instability with dynamic computed tomography

Athlani, Lionel; Rouizi, Kamel; Granero, Jonathan; Hossu, Gabriela; Blum, Alain; Dautel, G.; Teixeira, Pedro Augusto Gondim

doi:10.1177/1753193419893890

Cited by 26 publications

(18 citation statements)

References 15 publications

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“…Kinematic-CT can diagnose SLJ instability, especially when the conventional diagnostic evaluation is inconclusive [35][36][37][38]. It has been suggested that kinematic-MRI is a fast and reliable technique for detecting dynamic SLJ instability with a diagnostic accuracy comparable to dynamic fluoroscopy [39][40][41].…”

Section: Discussionmentioning

confidence: 99%

Interdisciplinary consensus statements on imaging of scapholunate joint instability

et al. 2021

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Objectives The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique. Methods Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors’ clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of ‘0’, ‘5’ and ‘10’ reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of ‘8’ or higher for 80% or more of the panellists. Results Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available. Conclusions Delphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability. Key Points • Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.

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Section: Discussionmentioning

confidence: 99%

Interdisciplinary consensus statements on imaging of scapholunate joint instability

et al. 2021

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“…[47][48][49] Four-dimensional CT achievable with devices with large detection system could play a role in the analysis of normal and pathologic kinematics of different joints. [50][51][52][53] CT angiography can be useful to evaluate vascular lesions and rule out a tumor 54,55 (►Fig. 7).…”

Section: Computed Tomographymentioning

confidence: 99%

Thumb Injuries and Instabilities. Part 1: Anatomy, Kinesiology, and Imaging Techniques of the Thumb

Blum

Holsbeeck

Bianchi

2021

Semin Musculoskelet Radiol

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The unique anatomical characteristics of the thumb offer a broad range of motion and the ability to oppose thumb and finger, an essential function for grasping. The motor function of the thumb and its orientation make it particularly vulnerable to trauma. Pathologic lesions encountered in this joint are varied, and imaging techniques play a crucial role in injury detection and characterization. Despite advances in diagnostic accuracy, acute thumb injuries pose a challenge for the radiologist. The complex and delicate anatomy requires meticulous and technically flawless image acquisition. Standard radiography and ultrasonography are currently the most frequently used imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations, and magnetic resonance imaging may be useful in equivocal cases. In this article, we present the relevant anatomy and imaging techniques of the thumb.

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“…In addition, the greater the variation in the scapholunate gap, the less stable the scapholunate joint, and the increased likelihood that the wrist would progress to scapholunate instability. Conversely, radiographic scapholunate diastasis that remains stable or exhibit minimal variations during wrist movements is not usually associated with a degree of instability that would progress to arthritis (Athlani et al., 2020). Thus, it should be possible to detect earlier stages of predynamic instability and treat these conservatively, while limiting the number of unnecessary repairs in stable lesions that have little risk of developing arthritis.…”

Section: Existing Challenges and The Futurementioning

confidence: 99%

Scapholunate injuries: challenging existing dogmas in anatomy and surgical techniques

Mathoulin¹,

Merlini²,

Taleb

2020

J Hand Surg Eur Vol

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The management of scapholunate injuries and dissociation remains debatable. Traditional methods of fixation had centred around open procedures, but advances in wrist arthroscopic techniques has redefined both major anatomical findings and operative approaches. This article challenges two main existing dogmas: first, the anatomy of the scapholunate ligament and second, the management of these injuries. For the first, we propose that scapholunate stability is in fact maintained by a whole anatomic complex, consisting of well-defined capsuloligamentous structures and extrinsic ligaments, and that the scapholunate ligament itself probably has a limited role. For the second, we challenge the notion that scapholunate injuries often require open procedures and propose that mini-invasive arthroscopic dorsal repair of the scapholunate complex is an efficient technique and sufficient for achieving long-term stability.

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Assessment of scapholunate instability with dynamic computed tomography

Cited by 26 publications

References 15 publications

Interdisciplinary consensus statements on imaging of scapholunate joint instability

Interdisciplinary consensus statements on imaging of scapholunate joint instability

Thumb Injuries and Instabilities. Part 1: Anatomy, Kinesiology, and Imaging Techniques of the Thumb

Scapholunate injuries: challenging existing dogmas in anatomy and surgical techniques

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