Diagnosing carpal instabilities using wrist cineradiography

The wrist is a complex joint, the stability of which is created by a balance between the bones of the wrist (carpal bones), the ligaments of the wrist and the tendons of the forearm. Carpal instability can be divided into three groups: carpal instability dissociative (CID), carpal instability non-dissociative (CIND), carpal instability combined (CIC). A well-known form of a CID is a scapholunar dissociation (SLD). An SLD can be further divided into three stages: predynamic, dynamic and static. As in dynamic and predynamic SLD the intercarpal relationships are not disrupted in the resting position, it is difficult to make an accurate diagnosis by means of a radiograph. It is important for the patient that an SLD should be diagnosed at the earliest stage possible in order to minimalize loss of function. Wrist cineradiography is the only dynamic radiological investigation that is able to image the carpal bones in real time while the wrist is moved in several directions. This investigation provides good images of the carpal bones and enables the visualization of the movement between the scaphoid and the lunate bones (amongst others). In this way it is possible to diagnose both predynamic and dynamic SLD. In this doctoral thesis we will focus on the diagnosing of an SLD by using the wrist cineradiography