The Diagnosis and Treatment of Scapholunate Instability

Manuel, Jennifer; Moran, Steven L.

doi:10.1016/j.ocl.2007.02.003

Cited by 35 publications

(15 citation statements)

References 96 publications

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“…It is therefore difficult to predict motion of the bones after ligament tears using current imaging and clinical techniques. The term scapholunate instability describes a spectrum of clinical conditions making a diagnosis of mild or moderate sprains not evident on xrays difficult to diagnose [1]. Linsheid [2] described scapholunate dissociation and detailed the loss of mechanical linkage between the scaphoid and lunate.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Ligament Length and Carpal Diastasis During Wrist Flexion–Extension and After Simulated Scapholunate Instability

Patterson

Yazaki

Andersen

et al. 2013

The Journal of Hand Surgery

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Purpose To determine the role of the carpal ligaments during wrist flexion/extension and to understand if maintaining integrity of only the dorsal scapholunate ligament is adequate for maintaining stability of the scapholunate joint. Methods This study combined motion analysis and manual digitization of ligament attachment regions to generate predictions of carpal ligament length and implied strain during wrist motion and length changes after simulated ligamentous injury. Results Thirteen ligaments and 22 ligament segments (sub portions) were modeled. Ligament length change with respect to wrist angle was measured. Eleven segments had minimum stretch or elongation from neutral wrist position over the entire wrist range of motion for any ligament cut condition. The remaining eleven segments had more than 10% stretch in some portion of flexion/extension. In general, ligaments had increased stretch during wrist flexion and after cutting the entire scapholunate ligament (SLL) and the dorsal intercarpal ligaments off the scaphoid. Conclusion Disruption of the membranous and palmar portions of the SLL and the dorsal intercarpal ligament off the scaphoid did not result in the development of an increased 3-dimensional scapholunate gap as measured by differences in ligament length calculations between the scaphoid and lunate. This may be indicative of a pre-dynamic instability condition (prior to clinical signs and x-ray findings) that is stabilized by the dorsal SLL preventing the increase in 3-dimensional scapholunate gap. This may also support surgical treatment recommendations, which suggest repair of the dorsal component only of the SLL will be effective. Disruption of the dorsal intercarpal ligament off the scaphoid or lunate did not result in further significant changes. Therefore the dorsal SLL has an important role in preventing scapholunate ligament instability. Clinical Relevance These results provide insight into the abnormal kinematics as various ligaments are compromised.

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Section: Introductionmentioning

confidence: 99%

Prediction of Ligament Length and Carpal Diastasis During Wrist Flexion–Extension and After Simulated Scapholunate Instability

Patterson

Yazaki

Andersen

et al. 2013

The Journal of Hand Surgery

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“…There have been a number of modifications to the original Blatt technique, 39,40 which theoretically will allow for more motion. To counteract this flexion deformity of the scaphoid, a dorsal capsulodesis is performed.…”

Section: Scapholunate Dissociationmentioning

confidence: 99%

Wrist pathology

and

Levin

2015

Plastic and Reconstructive Surgery

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For many wrist pathologies, a good physical exam is more helpful in determining the diagnosis than expensive imaging studies. However, it is imperative to have a thorough knowledge of wrist anatomy in order to correlate anatomical knowledge with specific pathologies. When performing a physical exam of the wrist it is helpful to approach the exam in a systematic way and compartmentalize the wrist based on anatomic regions. There are several physical exam manoeuvres and tests that can be performed to help in the diagnosis of specific wrist conditions. An anatomically based approach to wrist palpation will be presented followed by a discussion of common wrist problems that present to hand surgeons.

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“…In 1984, Watson and Ballet classified the progression of the SLAC wrist into three stages based on plain radiographs (Watson and Ballet, 1984;Watson et al, 1999) . This classification has gained worldwide acceptance (Manuel and Moran, 2007;Trail et al, 2007). In SLAC stage 1, degenerative changes are limited to the articulation between the tip of the radial styloid and radial aspect of the distal pole of the scaphoid.…”

Section: Scapholunate Advanced Collapsementioning

confidence: 99%

Reproducibility of radiographic classification of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist

Vishwanathan

Hearnden

Talwalkar³

et al. 2013

J Hand Surg Eur Vol

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The aim of this study was to measure inter- and intra-observer agreement on the radiographic classification of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist. Radiographs of 41 patients with SLAC wrist and 47 patients with SNAC wrist were graded on two separate occasions by four orthopaedic consultants specializing in hand and wrist surgery. Inter-observer agreement was evaluated using the multi-rater kappa value. Landis and Koch criteria were used to assess the level of agreement. Intra-observer agreement was tested by re-grading the radiographs after an interval of 2 to 4 weeks and calculating the weighted kappa value. For SLAC wrist, the inter-observer agreement was moderate (kappa value = 0.59) and intra-observer agreement substantial (kappa value = 0.65). For SNAC wrist, the inter-observer agreement was slight (kappa value = 0.20) and intra-observer agreement was fair (kappa value = 0.29). Radiographic classification of SLAC wrist has moderate reliability and reproducibility, whereas classification of SNAC wrist has limited reliability.

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The Diagnosis and Treatment of Scapholunate Instability

Cited by 35 publications

References 96 publications

Prediction of Ligament Length and Carpal Diastasis During Wrist Flexion–Extension and After Simulated Scapholunate Instability

Prediction of Ligament Length and Carpal Diastasis During Wrist Flexion–Extension and After Simulated Scapholunate Instability

Wrist pathology

Reproducibility of radiographic classification of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist

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