Scapholunate Ligament Tear

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Scapholunate Ligament Tear

Authors, Editors, Case Information Author: Jack Kilgore, MD Affiliation: Vanderbilt University Medical Center Department of Physical Medicine & Rehabilitation Co Author(s): Stephen Schaaf, MD Senior Editor: Carlton Covey, MD, MEd Clinical Vignette: A 49-year-old right-hand-dominant female presented with left dorsal wrist pain and popping after picking up heavy luggage. Exam of the left wrist was notable for tenderness over the scapholunate region and pain reproduction with wrist extension loading. Watson's (scaphoid shift) test produced pain w/o clunk. Type of Probe Used: 15-5 MHz Linear Array Transducer Unlabeled Long Axis View of the Scapholunate Ligament Unlabeled Long Axis View of the Scapholunate Ligament Labeled Long Axis View of the Scapholunate Ligament Labeled Long Axis View of the Scapholunate Ligament (SL) demonstrating a complete tear with a periosteal avulsion (Star) from the lunate Unlabeled Long Axis View of the Scapholunate Interval Measurement Unlabeled Long Axis View of the Scapholunate Interval Measurement demonstrating widening to approximately 7.6mm Labeled Long Axis View of the Scapholunate Ligament with Contralateral Comparison Labeled Long Axis View of the Scapholunate Ligament with Contralateral Comparison with affected (left) and unaffected (right) wrist demonstrating the sonographic difference between a completely torn and widened scapholunate ligament measuring approximately 7.6mm and an intact scapholunate ligament measuring approximately 4mm. Unlabeled Long Axis View of the Scapholunate Ligament with Contralateral Comparison Unlabeled Long Axis View of the Scapholunate Ligament with Contralateral Comparison #6 - Video View Video Long axis cine of the scapholunate ligament demonstrating widening of the scapholunate interval with dynamic evaluation involving radial and ulnar wrist deviation Interpretation Image Interpretation: Complete disruption of the dorsal scapholunate ligament near the scaphoid with a small hyperechoic foci within the scapholunate joint superficial to the lunate. Evidence of widening of the scapholunate joint distance to approximately 7.6 mm compared to approximately 4mm on the unaffected wrist. Additional scapholunate joint widening with radial and ulnar deviation. Teaching Pearl: Both static and dynamic ultrasound evaluations are important when assessing the dorsal scapholunate ligament. A complete tear is suggested by anechoic fiber discontinuity or nonvisualization of the ligament, and the measurement of scapholunate interval widening is more meaningful when compared with the contralateral wrist. Dynamic clenched-fist, axial loading, or radial-ulnar deviation maneuvers may reveal instability that is subtle at rest. Ultrasound can raise suspicion and localize the lesion, while radiographs, MRI, MR arthrography leading to hand surgery consultation may be needed for clinically significant instability. References: 1. Huber N, Götschi T, Schweizer A, Reissner L. Catch the shift: ultrasound diagnosis of scapholunate lesion during Watson test. Hand Surg Rehabil. 2024;43(5):101756. doi:10.1016/j.hansur.2024.101756 2. Taljanovic MS, Sheppard JE, Jones MD, Switlick DN, Hunter TB, Rogers LF. Sonography and sonoarthrography of the scapholunate and lunotriquetral ligaments and triangular fibrocartilage disk. J Ultrasound Med. 2008;27(2):179-191. doi:10.7863/jum.2008.27.2.179 3. Falsetti P, Conticini E, Baldi C, et al. Ultrasound evaluation of the scapholunate ligament and scapholunate joint space in patients with wrist complaints in a rheumatologic setting. J Ultrason. 2021;21(85):e105-e111. doi:10.15557/jou.2021.0019
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Scapholunate Ligament

Labeled Long Axis View of the Scapholunate Ligament

Unlabeled Long Axis View of the Scapholunate Interval Measurement

Labeled Long Axis View of the Scapholunate Ligament with Contralateral Comparison

Unlabeled Long Axis View of the Scapholunate Ligament with Contralateral Comparison

#6 - Video

Interpretation

UPCOMING EVENTS

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