Ultrasound Evaluation of the Scapholunate Ligament: Technique and Classification

Abstract

Objective

The objective of this study is to describe a systematized ultrasound evaluation technique of the scapholunate ligament (SLL) and to classify the different findings according to their severity in order to facilitate early diagnosis of this type of injuries.

Materials and Methods

We conducted a retrospective study of 13 patients evaluated in our clinics for wrist pain between February and August 2024, to whom we performed an ultrasound examination of the scapholunate ligament (SLL) and a subsequent arthroscopic study. We grouped the ultrasound images following the classification proposed by Kashiyama et al., modifying it to include new subgroups and taking into account the results of dynamic tests.

Results

Type A patients presented a normal ultrasound examination without pathology, where the SLL was visualized as a well-defined continuous hyperechoic line. Subtype B1 patients showed a preserved SLL with superficial inflammatory accumulations at the ligament and negative dynamic tests. In subtype B2 patients, the SLL was bulging and poorly defined with positive dynamic tests. 80% presented Geissler grade 2 injuries in arthroscopy. In Type C patients, it was not possible to delineate the SLL, but the opening of the scapholunate space was observed with radiocubital tilt movements and a positive Watson test was presented. 100% presented injuries, Geissler grade 3 and 4 in arthroscopy.

Conclusions

Ultrasound allows for the diagnosis of SLL injuries and their classification according to severity. Additionally, it enables dynamic studies, comparisons with the healthy contralateral wrist, and optimization of the therapeutic management of these patients.

Keywords

classification - ligament - ultrasound - scapholunate

Publication History

Received: 03 September 2024

Accepted: 24 March 2025

Article published online:
21 July 2025

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