The Optimal Location to Measure Scapholunate Diastasis on Screening Radiographs

Said, Joseph I.; Baker, K. Scott; Fernandez, Laviel; Komatsu, David E.; Gould, Elaine S.; Hurst, Lawrence C.

doi:10.1177/1558944717729219

Cited by 20 publications

(13 citation statements)

References 16 publications

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“…Standardized dorsopalmar and lateral radiographs remain the first-line imaging approach for assessing patients with SLJ instability where malalignment of the carpal bones may indicate static instability [12][13][14][15][16][17][18][19] (Fig. 1).…”

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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“…The distance between the scaphoid and lunate was measured at midjoint of the SL joint from the ulnar cortex of the scaphoid to the radial cortex of the lunate. [13][14][15] Radial inclination is the angle between the long axis of the radial shaft and a line connecting the tip of the radial styloid with the ulnar corner Ulnar variance is the difference in axial length between the ulnar corner of the distal radius and the most distal extent of the ulnar head.…”

Section: Methodsmentioning

confidence: 99%

“…The distance between the scaphoid and lunate was measured at midjoint of the SL joint from the ulnar cortex of the scaphoid to the radial cortex of the lunate. 13 14 15…”

Section: Methodsmentioning

confidence: 99%

Does Midcarpal Joint Structure Affect Development of Arthritis in the Wrist

et al. 2022

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Background Degenerative wrist arthritis develops in specific patterns because of forces acting on existing structural configurations. The most common pattern of wrist osteoarthritis is scapholunate advanced collapse (SLAC). Other patterns include isolated scaphotrapezial trapezoid (STT) joint and isolated midcarpal or radiolunate joint arthritis. One predictor of degeneration pattern is the structure of the wrist. Questions/Purposes Our purpose was to evaluate the relationship between midcarpal joint structure and the pattern of degenerative arthritis. We hypothesized that a wrist type 2 will preferentially develop SLAC degeneration. Patients and Methods We retrospectively evaluated 195 degenerative wrist radiographs. Radiographs were reviewed for lunate/wrist type, degeneration pattern, ulnar variance, radial and volar tilt, inclination, carpal height, scapholunate angle, gap, and presence of thumb carpometacarpal (CMC) joint, STT joint, and midcarpal joint arthritis. Results We had 158 radiographs with SLAC degeneration and 37 with atypical patterns, 154 type 2 and 41 type 1 wrists. There was a significant correlation between wrist type and the pattern of wrist degeneration (p = 0.02). SLAC degeneration developed in wrists with type 2 lunate while isolated midcarpal arthritis was associated with type 1 wrist. Isolated midcarpal joint arthritis was associated with STT arthritis, p < 0.01. Radial height, inclination, volar tilt, and ulnar variance, and scapholunate gap and angle were not associated with wrist type. Ulnar variance was associated with thumb CMC and STT joint arthritis while radial height was associated with isolated midcarpal joint arthritis. Conclusion This study found significant relationships between midcarpal joint structure and pattern of degeneration. This contributes to understanding the development of degeneration and can aid in future prevention of arthritis. Level of Evidence This is a Level IV, diagnostic study.

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“…1). Using the Carestream V 12.1.5.7 software, the scapholunate space was measured at the midpoint of the joint, between the Gilula lines 11 . The patients were analyzed and divided into two groups based on two cutoff points for the measurement of the scapholunate space: at 2 mm (group 1) and 2.5 mm (group 2) 12 .…”

Section: Measurements Classification and Treatmentmentioning

confidence: 99%

Correlation between the scapholunate space and clinical evolution in distal radius fractures

Villarreal-Calderón¹,

Martínez-Garza²,

Simental‐Mendía³

et al. 2023

RMU

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Introduction. Scapholunate instability is the most frequent carpal instability. It covers a wide spectrum of injuries and is usually associated with distal radius fractures. Objective. The aim of the study was to correlate the clinical evolution in patients with distal radius fractures with and without the opening of the scapholunate space. Methods. An observational, prospective, and comparative study was carried out at our institution. We included patients over 18 years of age with a diagnosis of distal radius fracture. The scapholunate space was measured, and pain and wrist functionality were evaluated after removing the cast and nails using the DASH and PRWE scales. Results. A total of 90 patients were included in the study. The mean age of the patients was 52.7 ± 16.8 years. About 56.7% were women, and 43.3% were men. A space < 2.5 mm was found in 34 (37.8%) and < 2 mm in 51 (56.7%). We found a decrease in scores over 8 weeks that was less than the baseline scores in patient groups with both an open and closed scapholunate space, indicating a better clinical outcome. We found a similar clinical course at 8 weeks in both groups. Conclusions. Patients with distal radius fractures present a favorable clinical evolution over the course of 8 weeks after the removal of the nails and plaster used to immobilize the fracture. The opening of the scapholunate space does not interfere with the prognosis of the patients.

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The Optimal Location to Measure Scapholunate Diastasis on Screening Radiographs

Abstract: Measurements in the middle of the scapholunate joint in neutral and 30° of ulnar deviation under fluoroscopic imaging best capture all stages of ligamentous disruptions. Measurements less than 2.0 mm at the middle of the scapholunate interval may be considered within normal range.

Cited by 20 publications

References 16 publications

Interdisciplinary consensus statements on imaging of scapholunate joint instability

Interdisciplinary consensus statements on imaging of scapholunate joint instability

Does Midcarpal Joint Structure Affect Development of Arthritis in the Wrist

Correlation between the scapholunate space and clinical evolution in distal radius fractures

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