A 52-year-old female presents with left wrist pain since a fall at work 4 months ago. The pain is exacerbated by extremes of motion. She reports associated clicking with wrist extension. On physical exam she has tenderness off the dorsal wrist. She has no obvious swelling and the skin is intact. Active ROM of motion shows 70 degrees of flexion and 50 degrees of extension. Her past medical history is noncontributory. Prior to referral to a hand specialist a trial of nonoperative treatment was attempted but did not lead to significant improvement.
What further imaging after radiographs, if any, would you order on this patient?
T3 MRI
MRI of the left wrist
CT scan of the left wrist
CT Arthogram
MR arthrogram left wrist
Would you perform wrist arthroscopy prior to deciding definitive treatment option prior to SL ligament reconstruction for chronic injury?
Yes
No
In a confirmed chronic scapholunate (SL) ligament injury, what is your preferred management?
Direct SL ligament REPAIR augmented with K-wire fixation
SL ligament RECONSTRUCTION (see next poll)
Reduction and Association of the Scaphoid and Lunate (RASL procedure) using a Herbert Screw
Scaphotrapezialtrapezoidal (STT) FUSION
Nonoperative for now, monitor for symptomatic SLAC wrist and perform PRC in future if needed
If choosing ligament RECONSTRUCTION (in confirmed chronic SL ligament injury), what technique would you use?
SL Reconstruction with FCR tendon transfer (+/- K-wire fixation)
SL Reconstruction with ECRB/ECRL tenodesis (+ K-wire fixation)
SL Reconstruction with allograft (+ K-wire fixation)
SL Reconstruction with partial ECRL and internal brace augmentation using knotless suture anchor fixation
If during wrist arthroscopy there was no evidence of chondral changes and the SL interval was reducible, would RASL be your first option?
Yes
No
Do you augment chronic SL ligament reconstruction with a dorsal capsulodesis?
Yes
No
How long do you immobilize the wrist after SL ligament reconstruction?
