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Ultrasound evaluation of the scapholunate ligament and scapholunate joint space in patients with wrist complaints in a rheumatologic setting

Paolo Falsetti
Paolo Falsetti
, 
Edoardo Conticini
Edoardo Conticini
, 
Caterina Baldi
Caterina Baldi
, 
Marco Bardelli
Marco Bardelli
, 
Suhel Gabriele Al Khayyat
Suhel Gabriele Al Khayyat
, 
Roberto D’Alessandro
Roberto D’Alessandro
, 
Luca Cantarini
Luca Cantarini
 y 
Bruno Frediani
Bruno Frediani
   | 18 jun 2021
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Article Category: research-paper
Publicado en línea: 18 jun 2021
Páginas: 105 - 111
Recibido: 30 dic 2020
Aceptado: 23 mar 2021
DOI: https://doi.org/10.15557/jou.2021.0019
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© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Axial dorsal scan on a normal wrist (10–22 MHz transducer). The scapholunate interosseous ligament appears as an echoic band (between calipers) connecting scaphoid (S) and lunate (L) bones. The ligament shows regular and homogeneous thickness, without discontinuity. The dorsal capsule (arrows) lies over the scapholunate joint
Axial dorsal scan on a normal wrist (10–22 MHz transducer). The scapholunate interosseous ligament appears as an echoic band (between calipers) connecting scaphoid (S) and lunate (L) bones. The ligament shows regular and homogeneous thickness, without discontinuity. The dorsal capsule (arrows) lies over the scapholunate joint

Fig. 2.

Dorsal scans on a symptomatic wrist (6–18 MHz transducer). Left side: axial scan. Moderate degeneration of scapholunate interosseous ligament (curved arrow), with inhomogeneous and hypoechoic echostructure, maldefinition and convexity of superficial profile. Right side: longitudinal scan. A hypoechoic synovial ganglion cyst (straight arrow) is visible below the deep surface of extensor digitorum communis tendon (EDCT). Note the absence of fluid in the midcarpal synovial space (arrowhead)
Dorsal scans on a symptomatic wrist (6–18 MHz transducer). Left side: axial scan. Moderate degeneration of scapholunate interosseous ligament (curved arrow), with inhomogeneous and hypoechoic echostructure, maldefinition and convexity of superficial profile. Right side: longitudinal scan. A hypoechoic synovial ganglion cyst (straight arrow) is visible below the deep surface of extensor digitorum communis tendon (EDCT). Note the absence of fluid in the midcarpal synovial space (arrowhead)

Fig. 3.

Dorsal axial scan on a rheumatoid wrist (6–18 MHz transducer). Severe degeneration of scapholunate interosseous ligament (absence of definite ligamentous structure), with dissociation >3.5 mm between scaphoid (S) and lunate (L) bones, consistent with scapholunate advanced collapse (SLAC). Active synovitis (asterisk) is detectable in the synovial space, as hypoechoic undisplaceable material with power Doppler signals
Dorsal axial scan on a rheumatoid wrist (6–18 MHz transducer). Severe degeneration of scapholunate interosseous ligament (absence of definite ligamentous structure), with dissociation >3.5 mm between scaphoid (S) and lunate (L) bones, consistent with scapholunate advanced collapse (SLAC). Active synovitis (asterisk) is detectable in the synovial space, as hypoechoic undisplaceable material with power Doppler signals

Fig. 4.

Dorsal scans on a symptomatic wrist (6–18 MHz transducer), healthy subject. Left side ( A ): axial scan. A hypoechoic synovial ganglion cyst is visible between the extensor digitorum communis tendon (EDCT) and extensor carpi radialis brevis (ECRB) tendon. Right side ( B ): longitudinal scan. Power Doppler signals are detected along the wall of the voluminous synovial ganglion cyst
Dorsal scans on a symptomatic wrist (6–18 MHz transducer), healthy subject. Left side ( A ): axial scan. A hypoechoic synovial ganglion cyst is visible between the extensor digitorum communis tendon (EDCT) and extensor carpi radialis brevis (ECRB) tendon. Right side ( B ): longitudinal scan. Power Doppler signals are detected along the wall of the voluminous synovial ganglion cyst

Fig. 5.

Dorsal scans on a wrist (6–18 MHz transducer), patient with calcium pyrophosphate dihydrates (CPPD) crystal deposition disease (CPDD) arthropathy. Left side: axial scan. Degeneration of scapholunate interosseous ligament (curved arrow), with inhomogeneous and hyperoechoic deposits. Right side: longitudinal scan. Hyperechoic deposits (calcifications suggestive for CPPD crystals, arrowhead) lie on the cartilage of capitate bone (C) and on the scapholunate joint space
Dorsal scans on a wrist (6–18 MHz transducer), patient with calcium pyrophosphate dihydrates (CPPD) crystal deposition disease (CPDD) arthropathy. Left side: axial scan. Degeneration of scapholunate interosseous ligament (curved arrow), with inhomogeneous and hyperoechoic deposits. Right side: longitudinal scan. Hyperechoic deposits (calcifications suggestive for CPPD crystals, arrowhead) lie on the cartilage of capitate bone (C) and on the scapholunate joint space

Fig. 6.

Dorsal axial scans on osteoarthritic wrists (6–18 MHz transducer). Degeneration of scapholunate interosseous ligament (arrowhead), with inhomogeneous echostructure and maldefinition. Enlargement of the scapholunate joint space (between calipers) and osteophytosis over the profile of scaphoid (S) bone
Dorsal axial scans on osteoarthritic wrists (6–18 MHz transducer). Degeneration of scapholunate interosseous ligament (arrowhead), with inhomogeneous echostructure and maldefinition. Enlargement of the scapholunate joint space (between calipers) and osteophytosis over the profile of scaphoid (S) bone

Demographic characteristics and ultrasound findings of patients as a whole and split up for final diagnosis. Data are expressed as means (± standard deviation) or percentages. The level of statistical significance was set at a p-level of 0.05

Overall Group 1 (no rheumatic or biomechanical disorders) Group 2 (degenerative diseases) Group 3 (inflammatory diseases) p values (statistical test)
Number 74 17 18 39
Age, in years (±SD) [range] 59.2 (± 14.2) [18–87] 43.4 (±13.6) [18–60] 64.1 (±6.2) [53–71] 62.7 (±13.1) [30–87] p <0.0001**(Kruskal-Wallis test)
Gender, males/females 28/46 4/13 5/13 19/20
Wrists analyzed 128 26 32 70
US grading of SLIL degeneration (mean) 1.1 (±0.63) 0.8 (±0.56) 1.18 (±0.53) 1.15 (±0.67) p <0.034*(Kruskal-Wallis test)
Mean US scapholunate diastasis in mm (± SD) [range] 2.67 (±0.66) [1.8–4.6] 2.51 (±0.49) [1.8–3.6] 2.70 (±0.56) [1.9–4.4] 2.69 (±0.7) [1.9–4.6] ns 0.503(Kruskal-Wallis test)
Wrists with scapholunate joint osteophytosis 54 (42.1%) 1 (3.8%) 16 (50%) 37 (52.8%) p <0.0001**(Chi-squared test)
Wrists with scapholunate space calcifications 28 (21.8%) 0 4 (12.5%) 23 (32.8%) p <0.0008**(Chi-squared test)
Wrists with dorsal ganglion cysts 42 (32.8%) 24 (92.3%) 11 (34.3%) 7 (10%) p <0.0001**(Chi-squared test)
Radiocarpal effusion 52 (40.6%) 0 8 (25%) 44 (62.8%) p <0.0001**(Chi-squared test)
Radiocarpal PDUS synovitis score (mean) 0.31 (±0.59) 0 0 0.58 (±0.71) P <0.0001**(Kruskal-Wallis test)
Midcarpal PDUS synovitis score (mean) 0.27 (±0.55) 0 0 0.50 (±0.67) p <0.0001**(Kruskal-Wallis test)
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