Significance of Scapholunate Gap Width as Measured by Probe from Midcarpal
16 February 2017
07 April 2017
16 May 2017 (eFirst)
Background Geissler's classification is widely accepted in arthroscopic diagnostics of scapholunate (SL) ligament injury. Thereby, probe insertion into the SL gap from the midcarpal would indicate treatment necessity in patients with SL tear as seen from radiocarpal view.
Purpose In this review, the SL gap width, examined by the probe from midcarpal, was arthroscopically assessed in patients with intact SL ligaments, who were treated for ulnar impaction syndrome. The review examined how often lax SL joints can be found in patients with no complaints with respect to the SL ligaments and in which the SL ligaments were proven to be intact from radiocarpal view. We suspected that probe insertion, as an indicator for a lax joint, does not affect the outcome in ulnar impaction treatment.
Patients and Methods A total of 32 patients with clinically diagnosed ulnar impaction syndrome were arthroscopically treated by central resection and debridement of the triangular fibrocartilage; 8 patients underwent concurrent ulnar shortening, and 4 of them finally hardware removal. All patients were examined preoperatively as well as after 3, 6, and 12 months following arthroscopy, respectively, after ulnar shortening or hardware removal.
Results In 14 patients, the probe could not, in 18 patients, the probe could be inserted into the SL gap. There was neither any significant difference in the improvement of pain, grip strength, Krimmer, or DASH score, nor for any of the radiographic angles between the two groups.
Conclusion Laxity of the SL ligament allows the probe to be inserted into the SL gap from midcarpal in some patients. This finding, therefore, does not necessarily imply the necessity of treatment when there is partial rupture seen from radiocarpal view.
Level of Evidence Level III, case–control study.
- 1 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (03) 357-365
- 2 Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg [Br] 1997; 22 (05) 638-643
- 3 Forward DP, Lindau TR, Melsom DS. Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 2007; 89 (11) 2334-2340
- 4 Löw S, Pillukat T, Prommersberger KJ, van Schoonhoven J. The effect of additional video documentation to photo documentation in wrist arthroscopies on intra- and interobserver reliability. Arch Orthop Trauma Surg 2013; 133 (03) 433-438
- 5 Löw S, Prommersberger KJ, Pillukat T, van Schoonhoven J. Intra- and interobserver reliability of digitally photodocumented findings in wrist arthroscopy [in German]. Handchir Mikrochir Plast Chir 2010; 42 (05) 287-292
- 6 Löw S, Spies CK, Unglaub F, van Schoonhoven J, Prommersberger KJ, Mühldorfer-Fodor M. Preventable repeat wrist arthroscopies -Analysis of the indications for 133 cases. J Wrist Surg 2017; 6 (01) 33-38
- 7 Watson HK, Ashmead IV D, Makhlouf MV. Examination of the scaphoid. J Hand Surg Am 1988; 13 (05) 657-660
- 8 Kalb K, Ludwig A, Tauscher A, Landsleitner B, Wiemer P, Krimmer H. Treatment outcome after surgical arthrodesis [in German]. Handchir Mikrochir Plast Chir 1999; 31 (04) 253-259
- 9 Megerle K, Pöhlmann S, Kloeters O, Germann G, Sauerbier M. The significance of conventional radiographic parameters in the diagnosis of scapholunate ligament lesions. Eur Radiol 2011; 21 (01) 176-181
- 10 Gelberman RH, Salamon PB, Jurist JM, Posch JL. Ulnar variance in Kienböck's disease. J Bone Joint Surg Am 1975; 57 (05) 674-676
- 11 Löw S, Herold A, Eingartner C. Standard wrist arthroscopy: technique and documentation [in German]. Oper Orthop Traumatol 2014; 26 (06) 539-546
- 12 Löw S, Erne H, Schütz A, Eingartner C, Spies CK. The required minimum length of video sequences for obtaining a reliable interobserver diagnosis in wrist arthroscopies. Arch Orthop Trauma Surg 2015; 135 (12) 1771-1777
- 13 Czitrom AA, Dobyns JH, Linscheid RL. Ulnar variance in carpal instability. J Hand Surg Am 1987; 12 (02) 205-208
- 14 De Smet L. Ulnar variance and its relationship to ligament injuries of the wrist. Acta Orthop Belg 1999; 65 (04) 416-417
- 15 Bain GI, Watts AC, McLean J, Lee YC, Eng K. Cable-augmented, quad ligament tenodesis scapholunate reconstruction. J Wrist Surg 2015; 4 (04) 246-251
- 16 Schädel-Höpfner M, Böhringer G, Junge A, Celik I, Gotzen L. Arthroscopic diagnosis of concomitant scapholunate ligament injuries in fractures of the distal radius [in German]. Handchir Mikrochir Plast Chir 2001; 33 (04) 229-233
- 17 van Kampen RJ, Bayne CO, Moran SL, Berger RA. Outcomes of capitohamate bone-ligament-bone grafts for scapholunate injury. J Wrist Surg 2015; 4 (04) 230-238
- 18 Wolfe SW. Scapholunate instability. J Am Soc Surg Hand 2001; 1: 45-60
- 19 Lutz MC, Erhart S, Deml C. Arthroscopically assisted osteosynthesis of intraarticular distal radius fractures [in German]. Oper Orthop Traumatol 2016; 28 (04) 279-290
- 20 Messina JC, Van Overstraeten L, Luchetti R, Fairplay T, Mathoulin CL. The EWAS classification of scapholunate tears: An anatomical arthroscopic study. J Wrist Surg 2013; 2 (02) 105-109
- 21 van Kampen RJ, Bayne CO, Moran SL. A new technique for volar capsulodesis for isolated palmar scapholunate interosseous ligament injuries: A cadaveric study and case report. J Wrist Surg 2015; 4 (04) 239-245
- 22 Schädel-Höpfner M, Böhringer G, Gotzen L, Celik I. Traction radiography for the diagnosis of scapholunate ligament tears. J Hand Surg [Br] 2005; 30 (05) 464-467