J Wrist Surg 2019; 08(01): 061-065
DOI: 10.1055/s-0038-1673344
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Twist X-Ray: A Novel Test for Dynamic Scapholunate Instability

Sheena K. Sikora
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
,
Stephen K. Tham
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
2   Victorian Hand Surgery Associates, Melbourne, Victoria, Australia
,
Jason N. Harvey
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
3   Orthosports Victoria, Epworth Hospital, Melbourne, Victoria, Australia
,
Marc Garcia-Elias
4   Institut Kaplan, Barcelona, Spain
,
Tony Goldring
5   Victoria House Medical Imaging, Melbourne, Victoria, Australia
,
Andrew H. Rotstein
5   Victoria House Medical Imaging, Melbourne, Victoria, Australia
,
Eugene T. Ek
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
6   Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
7   Department of Surgery, Monash Medical Centre, Monash University, Australia
› Author Affiliations
Further Information

Publication History

18 September 2017

27 August 2018

Publication Date:
03 October 2018 (online)

Abstract

Background Scapholunate instability (SLI) is the most common form of carpal instability. Early detection of SLI is imperative as early reconstructive procedures can potentially prevent the natural history of progressive degenerative arthritis. After wrist arthroscopy, magnetic resonance imaging (MRI) remains the next best noninvasive diagnostic option; however, access still remains costly and is often limited in many health care systems worldwide. In this article, we describe a novel device that allows for dynamic X-rays to be taken, accentuating the scapholunate (SL) widening.

Description of Technique Twist X-ray views are generated by the patient clenching a device that combines the standard clenched fist views with ulnar deviation and supination. The test is easy to perform and functions by combining a higher grip force with the ulnar deviation and pronation effects of the extensor carpi ulnaris tendon, thus accentuating the SL gap in dynamic instability.

Patients and Methods We present a series of four patients with dynamic SLI and compare the findings of the Twist X-rays with conventional wrist X-rays series, including standard anteroposterior, lateral, radial, and ulna deviation, clenched fist, and pencil grip views.

Results In all the four patients, there was substantial dynamic SL widening. The SL interval increased from a mean of 1.8 mm (range: 1.5–2.8) on posteroanterior X-rays to 6.3 mm (range: 4.6–8.2) with the Twist views. Interestingly, on the pencil grip view, the mean widening was only 1.5 mm (range: 1–2.8 mm).

Conclusion The authors describe a novel device that allows for improved detection of dynamic SL ligament instability when performing stress X-ray views of the wrist.

Level of Evidence This is a Level IV study.

Ethical Approval

The ethical approval was granted by Avenue Hospital Human Ethics Approval, Trial No. 199 (29/4/16).


 
  • References

  • 1 Kuo CE, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2008; 33 (06) 998-1013
  • 2 Spaans AJ, Minnen Pv, Prins HJ, Korteweg MA, Schuurman AH. The value of 3.0-tesla MRI in diagnosing scapholunate ligament injury. J Wrist Surg 2013; 2 (01) 69-72
  • 3 Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. Am J Roentgenol 2009; 192 (01) 80-85
  • 4 Lee SK, Desai H, Silver B, Dhaliwal G, Paksima N. Comparison of radiographic stress views for scapholunate dynamic instability in a cadaver model. J Hand Surg Am 2011; 36 (07) 1149-1157
  • 5 Rajan PV, Day CS. Scapholunate interosseous ligament anatomy and biomechanics. J Hand Surg Am 2015; 40 (08) 1692-1702
  • 6 Esplugas M, Garcia-Elias M, Lluch A, Llusá Pérez M. Role of muscles in the stabilization of ligament-deficient wrists. J Hand Ther 2016; 29 (02) 166-174
  • 7 Patel RM, Kalainov DM, Chilelli BJ, Makowiec RL. Comparisons of three radiographic views in assessing for scapholunate instability. Hand (NY) 2015; 10 (02) 233-238
  • 8 Lawand A, Foulkes GD. The “clenched pencil” view: a modified clenched fist scapholunate stress view. J Hand Surg Am 2003; 28 (03) 414-418
  • 9 Moneim MS. The tangential posteroanterior radiograph to demonstrate scapholunate dissociation. J Bone Joint Surg Am 1981; 63 (08) 1324-1326
  • 10 Hafezi-Nejad N, Carrino JA, Eng J. , et al. Scapholunate interosseous ligament tears: diagnostic performance of 1.5 T, 3 T MRI, and MR arthrography-a systematic review and meta-analysis. Acad Radiol 2016; 23 (09) 1091-1103
  • 11 Johnstone DJ, Thorogood S, Smith WH, Scott TD. A comparison of magnetic resonance imaging and arthroscopy in the investigation of chronic wrist pain. J Hand Surg [Br] 1997; 22 (06) 714-718