This narrative review by Kitay and Wolfe (HSS, 2012) examines scapholunate instability across its full spectrum — from occult partial tears with normal radiographs to end-stage SLAC arthritis — covering anatomy, kinematics, diagnostic workup, and a five-stage treatment algorithm.
When you see a wrist injury with dorsal SL tenderness and a positive scaphoid shift test but normal static radiographs, don't stop there — obtain stress views (clenched pencil PA) and consider 3T MRI or arthroscopy, because dynamic instability requires early intervention to prevent the irreversible progression through DISI to SLAC. Stage your patient using the five-question framework (ligament intact? repairable? scaphoid posture normal? reducible? cartilage preserved?) because the treatment — from arthroscopic debridement all the way to 4-corner fusion — is entirely dictated by stage.
This narrative review by Kitay and Wolfe (HSS, 2012) examines scapholunate instability across its full spectrum — from occult partial tears with normal radiographs to end-stage SLAC arthritis — covering anatomy, kinematics, diagnostic workup, and a five-stage treatment algorithm.
When you see a wrist injury with dorsal SL tenderness and a positive scaphoid shift test but normal static radiographs, don't stop there — obtain stress views (clenched pencil PA) and consider 3T MRI or arthroscopy, because dynamic instability requires early intervention to prevent the irreversible progression through DISI to SLAC. Stage your patient using the five-question framework (ligament intact? repairable? scaphoid posture normal? reducible? cartilage preserved?) because the treatment — from arthroscopic debridement all the way to 4-corner fusion — is entirely dictated by stage.