You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
ע"<br />
שת/<br />
תבט/<br />
ג"<br />
י<br />
14<br />
A WORD ABOUT INSTABILITIES..<br />
•Static (per standard Rx) vs. dynamic (per stress views)<br />
•Lunate position: Dorsal / Volar Intercalated Segmental Instability (DISI / VISI)<br />
•Mayfield classification<br />
DISI: 1) scapho-lunate dissociation; most common instability.<br />
*In radial styloid #<br />
disruption of scapholunate, scaphotrapezoid ligs., FCR floor & radiocarpal lig.<br />
Pain & tenderness in snuffbox / dorsal scapholunate joint + clicks<br />
Watson’s test (+ pain)<br />
Rx: scapholunate space >+3mm (Terry-Thomas sign); scaphoid “cortical ring”<br />
*comparison to other wrist<br />
Tx: arthroscopic tear resection, K-wire pinning (3-4w), ligaments repair<br />
& capsulodesis<br />
2) Scaphoid non-union / mal-union: prox. & dist. Fragments move indipendently<br />
Rx: high resolution CT scan<br />
Tx: correct fusion<br />
A WORD ABOUT INSTABILITIES..<br />
VISI: 1) lunotriquetral dissociation; can lead to synovitis, arthrosis & wrist pain<br />
Rx: may be normal (ulnar sided instabilities?)<br />
*L-T lig. Disruption alone cannot produce VISI<br />
Ulnar sided wrist pain motiom limit<br />
Shear test (+ pain)<br />
Tx: immobilization 4-6w inc. elbow, lig. debridement by arthroscopy<br />
2) Radiocarpal dissociation; in rheumatoid arthritis<br />
Compromise of dorsal radiocarpal capsule (inc. radiotriquetral lig.)<br />
OTHERS: 1) Radiocarpal instabilities; dist. Radius # (DISI), arthritis (ulnar)<br />
*Volar subluxation is rare<br />
2) Perilunate fracture-dislocations: in the lesser arc; can include<br />
greater arc and even distal radiolunate joint
Change language