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Scapholunate Instability
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Contents
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
- Direct trauma with wrist in extension and ulnar deviation
- Associated injuries
Risk Factors
- Ulna minus configuation[1]
- Slope of radial articular surface
- Lunotriquetral coalition
Differential Diagnosis
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- Pain and tenderness along carpal bones
- Scaphoid Shift Test: Pain with manipulation of scaphoid
Evaluation
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
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
Created by:
John Kiel on 18 June 2019 23:12:13
Authors:
Last edited:
13 October 2022 21:48:38
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