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Instability in the wrist can be caused by a torn Scapholunate ligament. The Brunelli Procedure does not fix the torn ligament. A hole is drilled through the Scaphoid bone and a part of a tendon taken from the patient is put through this hole and attached to the nearby bones. The procedure usually results in reduced movement of the wrist.
X-ray images indicate scapholunate ligament instability when the scapholunate distance is more than 3 mm, which is called scapholunate dissociation. [7] A static scapholunate instability is generally readily visible, but a dynamic scapholunate instability can only be seen radiographically in certain wrist positions or under certain loading conditions, such as when clenching the wrist, or ...
The initial treatment of patients with a suspected tear of the scapholunate and lunotriquetral interosseous ligament is a splint of the wrist. If the pain and instability persists, one could undergo an open surgery to reconstruct the scapholunate ligament. The lunotriquetral shear test may also be used.
Because SLAC results from scapholunate ligament rupture, there is a larger space between the two bones, also known as the Terry Thomas sign. [10] Scaphoid instability due to the ligament rupture can be stactic or dynamic. [11] When the X-ray is diagnostic and there is a convincing Terry Thomas sign it is a static scaphoid instability.
The examiner will feel a significant 'clunk' and the patient will experience pain if the test is positive. For completeness, the test must be performed on both wrists for comparison. If the scapholunate ligament is disrupted, the scaphoid will subluxate over the dorsal lip of the distal radius. Original Description by Watson:
An arthroscope can be used at the time of fixation to evaluate for soft-tissue injury and the congruity of the joint surface and may increase the accuracy of joint surface alignment [19] Structures at risk include the triangular fibrocartilage complex and the scapholunate ligament. Scapholunate injuries in radial styloid fractures where the ...
Scapholunate advanced collapse (also known as SLAC wrist) is a type of wrist osteoarthritis. SLAC wrist is the most common type of post-traumatic wrist osteoarthritis [ 1 ] and is often the result of an undiagnosed or untreated scapholunate ligament rupture. [ 2 ]
The CPT code revisions in 2013 were part of a periodic five-year review of codes. Some psychotherapy codes changed numbers, for example 90806 changed to 90834 for individual psychotherapy of a similar duration. Add-on codes were created for the complexity of communication about procedures.