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Scapholunate Instability

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Other Names

  • Scapholunate Ligament Injury
  • Scapholunate Injury
  • Dynamic scapholunate instability
  • Rotatory subluxation of the scaphoid
  • Scapholunate dissociation
  • Dorsal intercalated segment instability (DISI)
  • Scapholunate advanced collapse (SLAC)

Background

  • Refers to widening of the scapholunate space on radiographs involving injury to the Scapholunate Ligament
  • Most common and significant ligamentous injury of the wrist
  • Describes a spectrum of conditions, listed in order of increasing severity
    • Dynamic scapholunate instability
    • Rotatory subluxation of the scaphoid
    • Scapholunate dissociation
    • Dorsal intercalated segment instability (DISI)
    • Scapholunate advanced collapse

Pathophysiology


Risk Factors

  • Ulna minus configuation[1]
  • Slope of radial articular surface
  • Lunotriquetral coalition

Differential Diagnosis


Clinical Features


Evaluation

MRI in coronal plane showing scapholunate dissociation

Radiographs

  • Standard Radiographs Wrist
  • 3 views initially
  • Frequently missed due to normal appearance of initial radiographs
  • Scapholunate gap view
  • Clenched fist view: evaluate for dynamic wrist instability

Classification

  • N/a

Management

Nonoperative

  • Strongly encouraged to consult hand surgery with management decisions
  • Nonoperative/ conservative management is limited to dynamic scapholunate instability only
    • Includes
    • Activity modification
    • Physical Therapy
    • NSAIDS
    • Wrist Splinting

Operative

  • Indicated in most cases including:
    • Rotatory subluxation of the scaphoid
    • Scapholunate dissociation
    • Dorsal intercalated segment instability (DISI)
    • Scapholunate advanced collapse

Return to Play

  • At the discretion of the surgeon

Complications

  • Disease progression
    • Dynamic scapholunate instability
    • Rotatory subluxation of the scaphoid
    • Scapholunate dissociation
    • Dorsal intercalated segment instability (DISI)
    • Scapholunate advanced collapse

See Also


References

Created by:
John Kiel on 18 June 2019 23:12:13
Authors:
Last edited:
13 October 2022 21:48:38
Categories: