E

Figure 40-5—cont'd E, Diagram of a positive test.

Figure 40-6 Radiographic findings of scapholunate injury on a pos-teroanterior radiograph. Scapholunate interval of 3 mm or greater (white arrow). Flexed scaphoid appears as a cortical ring (black arrows).

Figure 40-7 Radiographic findings of scapholunate injury on lateral radiograph. A, Normal scapholunate angle is 30 to 60 degrees. This angle can be measured by a line bisecting the lunate and a line following the longitudinal axis of the scaphoid. B, A scapholunate angle greater than 60 degrees suggests injury to the scapholunate ligament.

Figure 40-7 Radiographic findings of scapholunate injury on lateral radiograph. A, Normal scapholunate angle is 30 to 60 degrees. This angle can be measured by a line bisecting the lunate and a line following the longitudinal axis of the scaphoid. B, A scapholunate angle greater than 60 degrees suggests injury to the scapholunate ligament.

the injury focuses on salvage procedures. The STT arthrodesis, also known as the triscaphoid arthrodesis, has commonly been used in the treatment of irreducible chronic scapholunate instability. The goal is to realign the radioscaphoid joint to minimize future degenerative change. Unfortunately, cases of joint deterioration after a lengthy reduced level of symptoms do occur and the incidence is unclear. Both range of motion and grip strength are lost after fusion. A meta-analysis of STT arthrode-sis reported in the literature revealed nonunion rates of approximately 13%.n Although scapholunate arthrodesis seems like the most logical treatment for this injury, nonunion rates are as high as 50%.11

Treatment of Chronic Instability with Arthritic Change

Patients with long-standing scapholunate instability who have developed arthritis will not have relief of symptoms with the previously mentioned procedures. The most common type of wrist arthritis is the SLAC (scapholunate advanced collapse) pattern described by Watson and Ballet12 (Fig. 40-8). Stage I

Figure 40-8 Stages of SLAC (scapholunate advanced collapse) wrist. A, Stage I begins with degenerative change at the radial styloid. B, Stage II reveals change along the entire radioscaphoid joint. C, Stage III reveals changes at the capitate-lunate articulation and proximal migration of the capitate.

begins with degenerative change between the radial styloid and distal pole of the scaphoid. Stage II reveals change along the entire radioscaphoid joint. Stage III reveals arthritic change of the capitate-lunate joint and proximal migration of the capitate. As the capitate continues to migrate proximally, pancarpal arthrosis develops. Patients will often present with decreased grip strength and stiffness with extension and radial deviation. In stage I disease, radial styloidectomy will decrease symptoms associated with impingement of the scaphoid on the radial styloid, but the underlying instability will lead to further deterioration. If the joint is reducible, a dorsal capsulodesis can be performed. If the joint is not reducible, an STT or scaphocapi-tate (SC) fusion can be performed in addition to the radial styloidectomy. In stage II disease, the arthritic radioscaphoid joint must be eliminated. This can be accomplished with either a proximal row carpectomy or a scaphoid excision and four-corner fusion (lunate-capitate-hamate-triquetrum), which is also known as the SLAC procedure. A proximal row carpectomy is considered by many to be contraindicated if arthritic change is present on the proximal capitate. Both the SLAC procedure and proximal row carpectomy will lead to decreased grip strength and range of motion compared to the normal wrist. After proximal row carpectomy, patients retain approximately 52% of motion and 67% of grip strength compared to the normal wrist.13 Although stage II disease may be treated with a variety of procedures, proximal row carpectomy was found to retain the most motion.14 Patients with stage III disease may be treated with either the SLAC procedure or total wrist arthrodesis. A proximal row carpectomy is contraindicated if arthritic change is present on the proximal capitate. The ideal position for wrist arthrodesis is 10 degrees of extension and neutral or slight ulnar deviation.

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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