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: 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 produced pain w/o clunk. Type of Probe Used: 15-5 MHz Linear Array Transducer #1 - Video View Video Transverse axis view of the dorsal wrist demonstrating widening of the scapholunate interval with dynamic evaluation involving radial and ulnar wrist deviation Scapholunate Contralateral Comparison Contralateral comparison of the affected (left) and unaffected (right) wrist demonstrating the sonographic difference between a completely torn and widened scapholunate ligament and an intact scapholunate ligament Scapholunate Interval Measurement Transverse axis view of the dorsal wrist scapholunate interval demonstrating widening to 7.6mm Scapholunate Ligament Tear Transverse axis view of the dorsal wrist and scapholunate ligament Interpretation Image Interpretation: Dorsal scapholunate joint and ligament: There was complete disruption of the dorsal scapholunate ligament near the scaphoid. There was a small hyperechoic foci within the scapholunate joint superficial to the lunate. On static evaluation, there was widening of the scapholunate joint distance to 7.6 mm. In comparison, the scapholunate joint distance on the contralateral unaffected wrist was 4 mm. On dynamic evaluation with radial and ulnar deviation, there was additional scapholunate joint widening. Sonopalpation tenderness was present over this region. Teaching Pearl: A combination of both static and dynamic ultrasound evaluation is critical when assessing for a dorsal scapholunate ligament tear. A complete scapholunate ligament tear is suspected when anechoic ligament fiber discontinuity is present. On static measurement, a scapholunate interval of greater than 5mm, or greater than 1mm wider than the contralateral unaffected side should be considered abnormal and raise concern for a dorsal scapholunate ligament tear. In contrast, plain radiographs showing >2mm of widening is considered concerning. The discrepency is related to the ability for the US to measure ligament directly; increasing its accuracy. Dynamically, there are several maneuvers that can be performed. Radial and ulnar deviation are the authors preferred maneuvers to create stress on the scapholunate interval. Widening of the interval greater than 1mm which typically occurs with ulnar deviation should be considered abnormal in comparison to the static measurement. The scapholunate ligament has three bands: the dorsal, central, and volar, with the dorsal band being the most robust and primary stabilizer, thus making it the most clinically important if torn when it comes to operative repair or reconstruction.
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

#1 - Video

Scapholunate Contralateral Comparison

Scapholunate Interval Measurement

Scapholunate Ligament Tear

Interpretation

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