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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 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:
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. Arthroscopy is until today in an experimental stage but research suggest that in the near future it will be a reasonable alternative for open surgery due to faster recovery time. [6]
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.
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 rationale is that ligament reconstruction(LR) helps maintain the gap between the metacarpal and the scaphoid, and that a larger gap is associated with greater comfort and capability. [32] Again these possibilities are not supported by experimental evidence. During this procedure the anterior oblique ligament is reconstructed using the FCR ...
The palmar surface of the scaphoid is concave, and forming a distal tubercle, giving attachment to the transverse carpal ligament. The proximal surface is triangular, smooth and convex. [3] The lateral surface is narrow and gives attachment to the radial collateral ligament. The medial surface has two facets, a flattened semi-lunar facet ...