Purpose
Scapholunate dissociation (SLD) is thought to be a common cause of both acute and
chronic wrist pain. Classically, this condition is attributed to a traumatic event
and is thought to inevitably lead to the development of degenerative arthritis. Bilateral
findings should thus be infrequent. The purpose of the present study was to determine
the incidence of bilateral radiographic SLD and associated arthritic changes.
Methods
Demographic, radiographic, and clinical data were obtained from 124 patients with
abnormal x-ray findings in at least 1 wrist. Radiographs reviewed included posteroanterior,
lateral, and Moneim views of both symptomatic and asymptomatic wrists. Pathology was
defined as a scapholunate gap ≥ 5 mm and/or a scapholunate angle ≥ 60°. Arthritic
changes were assessed.
Results
A majority of the 124 patients (51%) were unable to recall any specific injury to
their wrist. On the symptomatic side, 101 (81%) patients had a pathologic measurement
for their scapholunate gap, and 109 (88%) had an abnormal angle measurement. On the
asymptomatic side, 64 (52%) of the gap measurements and 87 (70%) of the angle measurements
were pathologic. Ninety-nine patients (80%) had abnormal radiographic findings bilaterally
for at least 1 variable on each side. Only 13 patients (11%) had a clinical instability
pattern typical of SLD. Half the patients had radiographic degenerative changes at
presentation.
Conclusions
Bilateral radiographic SLD is much more common than previously assumed, is often asymptomatic,
and does not inevitably lead to degenerative arthritis. These findings should call
into question the assumption of a uniquely traumatic etiology. Further, most patients
presented with pathologies unrelated to the scapholunate articulation. Surgical intervention
chosen on the basis of radiologic findings, in the absence of clinical instability,
might not be the best course of action, unless criteria are established to determine
which patients eventually develop arthritic changes or become symptomatic.
Type of study/level of evidence
Therapeutic III.
Key words
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Article info
Publication history
Published online: May 02, 2012
Accepted:
March 12,
2012
Received:
May 23,
2011
Footnotes
We would like to acknowledge the contributions of Mark S. Klug, MD, and William Littlefield, MD, for allowing us to include several of their patients in the analysis. We would also like to thank Ronald J. Markert, PhD, for his advice in the statistical analyses and William Vitello, MD, for helping to develop some of the preliminary concepts of this project. Phyllis Salyers offered invaluable organizational support over many years.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
