Images in Clinical Rheumatology
Scapholunate ligament: A fundamental structure in the stability of the wrist
Ligamento escafosemilunar: una estructura fundamental en la estabilidad de la muñeca
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Imágenes axial (A) y coronal (B) de la muñeca izquierda en secuencias potenciadas en T2 con supresión grasa (SPAIR). Se objetiva una rotura completa de la porción dorsal del ligamento escafosemilunar (flecha) que produce una diástasis significativa entre el hueso escafoides (E) y el semilunar (S) con mínima cantidad de derrame y signos de sinovitis. No se objetivan focos de señal de resonancia similar a edema óseo que sugieran inflamación/artritis ni cambios artrósicos significativos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Darío Herrán de la Gala, María Sáenz Aldea" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Darío" "apellidos" => "Herrán de la Gala" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Sáenz Aldea" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574321001908" "doi" => "10.1016/j.reumae.2021.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321001908?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X21001352?idApp=UINPBA00004M" "url" => 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"aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Sáenz Aldea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Medicina Familiar y Comunitaria, Centro de Salud Dávila, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ligamento escafosemilunar: una estructura fundamental en la estabilidad de la muñeca" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 828 "Ancho" => 1255 "Tamanyo" => 124381 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior plain radiograph of the left wrist (A) with magnified detail (B). There is a significant diastasis between the lunate and scaphoid bones of the carpus (double-headed arrow), which in the manual measurement was 3.5 mm. In addition, a rotatory subluxation of the scaphoid bone (B) is seen, which is an indirect indicator of scapholunate ligament injury, although it is visible in other injuries of different wrist stabilisers.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The scapholunate ligament complex is a set of ligaments that provide attachment between the scaphoid and lunate bones of the carpus. It is divided into 3 components: dorsal, volar and secondary stabilisers. Of these, the dorsal is the thickest and strongest, and its rupture is the most important clinically and biomechanically<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Its rupture is secondary to trauma, although it can also rupture atraumatically in chronic gout. Diagnosis is often delayed, as it is a clinically and radiologically underdiagnosed finding due to its lack of specificity: plain radiography may be normal in the acute setting<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and is the test of choice. Over time, there is a diastasis between the lunate and the scaphoid greater than 3 mm on the posteroanterior wrist plain radiograph<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. This condition predisposes to the development of early wrist osteoarthritis secondary to carpal instability, following a pattern known as SLAC wrist (ScaphoLunate Advanced Collapse)<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>. Full characterisation of the degree and severity of ligamentous injury is assessed with wrist MRI<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a>. Based on the patient’s age and activity, a conservative or surgical approach may be considered<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The case presented is that of a 30-year-old left-handed male who consulted for episodes of intermittent chronic pain in the dorsal aspect of the left wrist, which partially subsided after taking anti-inflammatory drugs. The condition began following an accidental fall from his height 2 years earlier, for which he did not consult. A posteroanterior wrist X-ray showed a scapholunate diastasis of 3.5 mm and a rotatory subluxation of the scaphoid (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The study was completed with ultrasound and magnetic resonance imaging (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>), which demonstrated a complete rupture of the dorsal component of the scapholunate ligament. The patient was referred to the Hand Unit for consultation, where surgical treatment with arthroscopic ligamentoplasty was decided.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The scapholunate ligament is a fundamental element in the stability of the wrist. Its rupture is not particularly uncommon and is usually represented in all imaging tests. Therefore, all specialists involved in the management of these patients should be familiar with the radiological semiology of this entity.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0020" class="elsevierStylePara elsevierViewall">None of the authors have any conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-04-12" "fechaAceptado" => "2021-05-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Herrán de la Gala D, Sáenz Aldea M. Ligamento escafosemilunar: una estructura fundamental en la estabilidad de la muñeca. Reumatol Clin. 2022;18:186–187.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 828 "Ancho" => 1255 "Tamanyo" => 124381 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior plain radiograph of the left wrist (A) with magnified detail (B). There is a significant diastasis between the lunate and scaphoid bones of the carpus (double-headed arrow), which in the manual measurement was 3.5 mm. In addition, a rotatory subluxation of the scaphoid bone (B) is seen, which is an indirect indicator of scapholunate ligament injury, although it is visible in other injuries of different wrist stabilisers.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 707 "Ancho" => 1255 "Tamanyo" => 91605 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ultrasound images of the wrist with a high-frequency linear probe; dorsal approach. In the static scan (left image), the scapholunate space appears to be preserved, although a certain hypoechogenicity of the scapholunate ligament can be sensed. However, in the dynamic scan (right image), there is a marked hypoechogenicity with significant scapholunate diastasis, without identifying the ligament with definition, in the context of its rupture.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 653 "Ancho" => 1255 "Tamanyo" => 81729 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging. Axial (A) and coronal (B) images of the left wrist in T2-weighted sequences with fat suppression (SPAIR). There is a complete rupture of the dorsal portion of the scapholunate ligament (arrow) producing a significant diastasis between the scaphoid bone (E) and the lunate (S) with minimal effusion and signs of synovitis. There are no foci of MRI signal similar to bone oedema suggestive of inflammation/arthritis or significant osteoarthritic changes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The gross and histologic anatomy of the scapholunate interosseous ligament" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.A. 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Arndt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13244-014-0337-1" "Revista" => array:6 [ "tituloSerie" => "Insights Imaging" "fecha" => "2014" "volumen" => "5" "paginaInicial" => "407" "paginaFinal" => "417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24891066" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MR and CT arthrography of the wrist" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Cerezal" 1 => "J. de Dios Berná-Mestre" 2 => "A. Canga" 3 => "E. Llopis" 4 => "A. Rolon" 5 => "X. 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Bagg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ocl.2019.09.002" "Revista" => array:6 [ "tituloSerie" => "Orthop Clin North Am" "fecha" => "2020" "volumen" => "51" "paginaInicial" => "77" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31739882" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001800000003/v1_202203090817/S2173574321001908/v1_202203090817/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001800000003/v1_202203090817/S2173574321001908/v1_202203090817/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321001908?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 4 | 10 |
| 2024 October | 65 | 58 | 123 |
| 2024 September | 77 | 53 | 130 |
| 2024 August | 118 | 66 | 184 |
| 2024 July | 127 | 57 | 184 |
| 2024 June | 71 | 61 | 132 |
| 2024 May | 57 | 49 | 106 |
| 2024 April | 76 | 52 | 128 |
| 2024 March | 66 | 59 | 125 |
| 2024 February | 55 | 48 | 103 |
| 2024 January | 117 | 54 | 171 |
| 2023 December | 58 | 53 | 111 |
| 2023 November | 107 | 64 | 171 |
| 2023 October | 108 | 54 | 162 |
| 2023 September | 127 | 68 | 195 |
| 2023 August | 79 | 34 | 113 |
| 2023 July | 57 | 59 | 116 |
| 2023 June | 76 | 42 | 118 |
| 2023 May | 79 | 58 | 137 |
| 2023 April | 52 | 34 | 86 |
| 2023 March | 78 | 64 | 142 |
| 2023 February | 68 | 54 | 122 |
| 2023 January | 67 | 38 | 105 |
| 2022 December | 83 | 81 | 164 |
| 2022 November | 89 | 55 | 144 |
| 2022 October | 77 | 35 | 112 |
| 2022 September | 68 | 48 | 116 |
| 2022 April | 2 | 1 | 3 |
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