 46yo male presents with    T 98.4 P 74 BP 138/80 chief complaint of left      O2 100% wrist pain. Patient         Gen ...
 scapholunate dissociation scaphoid impaction syndrome (SIS) occult ganglion cyst posterior interosseous nerve neuroma...
White arrow: "Terry Thomas"sign gap between scaphoid and lunate, normal 1-2 mm(abnormal 3mm) Progressive flexion and fores...
 Orthopedic follow up, for most cases will need  operative repair of interosseous ligament. Can place patient in thumb s...
 MCC of carpal instability Assoc. injuries: simultaneous radial styloid fx is relatively  common w/ carpal dislocation; ...
 http://www.wheelessonline.com/ortho/scapholunate_    instability   http://fhs.mcmaster.ca/surgery/documents/scapholu   ...
Scapholunate dissociation (1)
Scapholunate dissociation (1)
Scapholunate dissociation (1)
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Scapholunate dissociation (1)

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Scapholunate dissociation (1)

  1. 1.  46yo male presents with  T 98.4 P 74 BP 138/80 chief complaint of left O2 100% wrist pain. Patient  Gen NAD slipped on side walk on  MSK pain to dorsum of sheet of ice and fell left wrist just proximal to forward, landing on 3rd metacarpal. 2+ distal outstretched hand. Pain pulses. Pain with wrist has been lingering for rotation past two days, and pt endorses “clicking”  Neuro: motor 5/5 nl sound with certain wrist sensation movements
  2. 2.  scapholunate dissociation scaphoid impaction syndrome (SIS) occult ganglion cyst posterior interosseous nerve neuroma physiologic scapholunate (compare to other hand) perilunate dislocation non-displaced scaphoid fx
  3. 3. White arrow: "Terry Thomas"sign gap between scaphoid and lunate, normal 1-2 mm(abnormal 3mm) Progressive flexion and foreshortening of the scaphoid leads to the scaphoidring sign, seeing scaphoid end on.Black arrow: Signet Ring sign- seen with abnormal palmar flexion of scaphoid.Right Image: Scapholunate angle nl 30-60 degrees, >80 degrees diagnostic of DISI (dorsalintercalated segment instability) signifying carpal instability
  4. 4.  Orthopedic follow up, for most cases will need operative repair of interosseous ligament. Can place patient in thumb spica splint and have patient f/u with ortho within one week. Untreated, SLD can lead to DISI, defined by SL angle >80 degrees due to abnormal flexion of scaphoid, indicating wrist instability, and if further untreated, can lead to severe arthritis; thus prompt ortho f/u necessary
  5. 5.  MCC of carpal instability Assoc. injuries: simultaneous radial styloid fx is relatively common w/ carpal dislocation; also always consider non- displaced scaphoid fx. Mechanism is similar to that of scaphoid fx, w/ stress loading of extended carpus, except it is usually in ulnar rather than radial deviation SL angle greater than 80 degrees indicative of DISI, which can occur with SLD left untreated, and is indicative of worsened carpal instability. DISI can lead to scapholunate advance collapse (SLAC), a specific pattern of osteoarthritis and subluxation which results from untreated chronic SLD.
  6. 6.  http://www.wheelessonline.com/ortho/scapholunate_ instability http://fhs.mcmaster.ca/surgery/documents/scapholu nate_dissociation.pdf http://www.rcsed.ac.uk/fellows/lvanrensburg/classific ation/hand/scapholunate_diss.htm http://emedicine.medscape.com/article/1244215- overview http://www.radsource.us/clinic/0906 http://www.wheelessonline.com/ortho/x_ray_findings _in_sld
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