Scapholunate instability: Natural history, diagnostics, and therapeutic algorithm

Abstract

Scapholunate joint takes approximately 80% of axial and rotational wrist load. Lesion of scaphoid ligaments leads to its instability especially in dorsal flexion and ulnar deviation mechanism. Increase of scapholunate gap can be found in 19% of patient with wrist injury, 2 of them needs surgical intervention because of severe instability. In 2002 to 2005 in Traumatology, Orthopedics and Hand Surgery Department at Poznan University of Medical Sciences 36 patients were treated due to painful wrist of unknown etiology. Diagnostic possibilities, the value of some imaging methods used in scapholunate instability (SLI) were described. Clinical examination with use of provocational tests, classical X-ray, both static and stress, MRI with contrast, dynamic fluoroscopy were and arthroscopy taken under scope. This paper describes also approach to treatment possibilities of SLI including capsulodesis, static and dynamic stabilization with ligaments and partial or total arthrodesis.