The Diagnosis and Treatment of Scapholunate Instability

Manuel, Jennifer; Moran, Steven L.

doi:10.1016/j.hcl.2009.08.006

Cited by 57 publications

(46 citation statements)

References 97 publications

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“…The treatment of chronic static SL dissociation remains controversial. 1 Patients with chronic static SL dissociation usually have complete detachment of the dorsal SL ligament with elongation of the secondary stabilizers. 5 Several surgical procedures have been recommended for the treatment of this stage of scapholunate dissociation, including limited arthrodesis, 6 capsulodesis, 7,8 tenodesis, 5 proximal row carpectomy, 9 and bone-ligament-bone reconstuction.…”

mentioning

confidence: 99%

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

2013

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The purpose of this study was to examine the radiographic outcomes of dorsal intercarpal ligament capsulodesis (DILC), documenting the time to carpal collapse postoperatively. From January 2008 to January 2011, 12 patients were identified with chronic scapholunate (SL) dissociation. The average follow-up period was 15.8 months.Paired t-tests were used preoperatively, one month after pin removal, and at final followup to determine significance in radiographic outcomes. The Disabilities of the Arm, Shoulder, and Hand (DASH) survey was administered to patients before and after surgery to assess subjective levels of pain, function, and satisfaction. Intraoperatively all deformities were reduced completely. One month after pin removal, the mean SL gap was 3.3 mm, the SL angle was 74°, the radiolunate (RL) angle was 17°, and the lunatocapitate (LC) angle was 8°. Only the SL angle improved; the other measurements remained unchanged. At final follow-up, the mean SL gap was 3.6 mm, the SL angle was 78°, the RL angle was 20°, and the LC angle was 10°. SL angle worsened, but with no statistically significant difference. The other radiographic measurements remained unchanged at final follow up. Wrist flexion and extension decreased from 76% and 69% of the contralateral side to 62% and 56% of the contralateral side after surgery. Grip strength was 64% of the contralateral side before surgery and 83% after surgery. Visual Analog Scale (VAS) results improved from 6.3 to 1.7, and DASH scores improved from 39 to 8 after the surgery. DILC cannot withstand large and repetitive forces. Carpal collapse recurred within a short time after DILC. However, our small patient numbers and short term follow-up preclude any conclusions with respect to clinical efficacy of this procedure. Limitations of this study include the fact that this is a retrospective study with no control group. In addition, it represents a single-surgeon series, which introduces a source of bias and carries the risk of technical and methodological flaws, which may have contributed to the observed radiographic outcomes.

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confidence: 99%

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

2013

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“…One study comparing different views of the SL ligament concluded that a clenched fist view with 30° ulnar deviation (AP) resulted in the biggest SL gap: a Terry-Thomas sign of 4.55 mm (same as in a clenched pencil view). [58][59][60][61] • Level of evidence (Oxford Centre for Evidence-based Medicine): 4.…”

Section: Plain Filmmentioning

confidence: 99%

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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“…Definitive diagnosis is usually confirmed with MRI (with or without arthrography). The use of wrist arthroscopy for diagnosis and treatment of partial tears of the SL ligament is a current topic of research interest [18][19][20].…”

Section: Scapholunate Interosseous Ligament Tearmentioning

confidence: 99%

“…Gradual return to sport is based on symptomatology. Complete acute tears of the SL ligament should be managed early with surgical repair to avoid static changes in carpal alignment [15,19,21]. While several techniques for ligament repair and reconstruction have been described, we favor direct ligament repair through a dorsal approach using a suture anchor with 2 supplementary Kirschner wires transfixing the SL interval and an additional wire from the scaphoid to the capitate.…”

Section: Scapholunate Interosseous Ligament Tearmentioning

confidence: 99%

Sports injuries of the wrist

Fufa

Goldfarb

2012

Curr Rev Musculoskelet Med

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Sports injuries involving the hand and wrist are common and, as a result, many different practitioners (athletic trainers, physical therapists, primary care physicians, general orthopedic surgeons) will encounter these injuries. In addition to thorough evaluation, an understanding of typical pathologies seen in the athlete enhances diagnosis and facilitates appropriate, expedient management. These injuries are complex because they can be either acute traumatic or repetitive in origin and often involve both the bony skeleton and soft tissues. This article provides a review of athletic injuries to the wrist with particular focus on physical evaluation and management of the most common and challenging fractures and soft tissue injuries.

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The Diagnosis and Treatment of Scapholunate Instability

Cited by 57 publications

References 97 publications

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

Hand examination and investigations

Sports injuries of the wrist

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