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Radiologische Frühdiagnostik der skapholunären Dissoziation (SLD)

Early radiological diagnostics for scapholunate dissociation (SLD)

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Zusammenfassung

Die Teilruptur des Lig. scapholunatum (prädynamisches Stadium) und die isolierte Komplettruptur (dynamisches Stadium) führen zu keiner karpalen Gefügestörung in Ruhe. Erst wenn die Komplettruptur von Läsionen der extrinsischen Bandstabilisatoren begleitet wird, stehen das Skaphoid und Lunatum bereits in Ruhe in Fehlstellung (statisches Stadium). Später kommt es zur Handgelenkarthrose, zuerst radioskaphoidal, dann mediokarpal mit Ausbildung eines karpalen Kollapses (arthrotisches Stadium). Die dynamische Instabilität ist nur mit Stressaufnahmen und kinematographisch nachweisbar. Die MRT vermag das rupturierte Lig. scapholunatum direkt darzustellen: Intravenös verabreichtes Kontrastmittel reichert sich fokal am Reparationsgewebe der Rupturstelle an; mit der direkten MR-Arthrogaphie können die Bandsegmente besser abgegrenzt und Partial- von Komplettrupturen unterschieden werden.

Abstract

The partial tear of the scapholunate ligament (pre-dynamic stage of SLD) as well as the complete tear (dynamic stage) does not lead to carpal malalignment. However, if the completely ruptured ligament is accompanied by lesions of the extrinsic ligaments, both the scaphoid and the lunate are malaligned already at rest (static stage of SLD). Later, osteoarthritis will develop, beginning in the radioscaphoid compartment, progressing to the midcarpal joint, and ending in a carpal collapse (osteoarthrotic stage of SLD). Dynamic SLD is detectable only in stress views and in cinematography. The high utility of MRI for directly visualizing the injured ligament is emphasized: reparation tissue is focally enhanced at the rupture site by intravenously applied contrast agent; the individual segments of the scapholunate ligament can be visualized in direct MR arthrography, therefore allowing differentiation of partial and complete ligamentous tears.

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie, Herz- und Gefäßklinik GmbH, Salzburger Leite 1, 97616 , Bad Neustadt an der Saale

    R. Schmitt, S. Fröhner, S. Fodor & G. Christopoulos

  2. Klinik für Handchirurgie, Herz- und Gefäßklinik GmbH Bad Neustadt an der Saale

    K. H. Kalb

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  1. R. Schmitt
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  2. S. Fröhner
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  3. S. Fodor
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  4. G. Christopoulos
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  5. K. H. Kalb
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Correspondence to R. Schmitt.

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Schmitt, R., Fröhner, S., Fodor, S. et al. Radiologische Frühdiagnostik der skapholunären Dissoziation (SLD). Radiologe 46, 654–663 (2006). https://doi.org/10.1007/s00117-006-1400-9

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