Original Communications: WristThe “clenched pencil” view: A modified clenched fist scapholunate stress view☆,☆☆,*
Section snippets
Technique
The required materials are a pencil (or wooden dowel), one 10 × 12 radiographic cassette, and a standard x-ray machine. The patient is instructed to grip the pencil with both fists. The index fingers should be apposed tightly to each other and the thumb metacarpals should be lying down on the cassette (Fig. 1A).
Discussion
Historically the diagnosis of scapholunate dissociation is made by history and physical examination and confirmed by posteroanterior and lateral radiographs (if static) or a clenched fist stress view (if dynamic).1 Findings on routine posteroanterior views include a widened scapholunate gap, foreshortening or flexion of the scaphoid (the ring sign), and an abnormal relationship of the proximal carpal row.2 Standard posteroanterior and lateral radiographs of the wrist may not reveal a defect.
References (4)
- et al.
Advanced techniques in the management of wrist trauma. Arthroscopic and open management of dynamic scaphoid instability
Orthop Clin North Am
(2001) - et al.
Traumatic instability of the wrist
Cited by (38)
Dynamic X-rays of the wrist: Which indications, which protocols and diagnostic value?
2023, Revue du Rhumatisme (Edition Francaise)Bilateral Ulnar Deviation Supination Stress Test to Assess Dynamic Scapholunate Instability
2022, Journal of Hand SurgeryCitation Excerpt :The clenched fist stress view has become the most popular technique to assess SL diastases. To widen the SL interval, a compressive force, generated by making a full fist while grasping a pencil, is applied across the midcarpal joint.7,17,18 The dissociated lunate is expected to be pushed into dorsiflexion by the capitate, because of its wedge shape, while the scaphoid rotates into flexion.
CMC Mimickers: Differential Diagnosis and Work-Up for Radial-Sided Wrist Pain
2022, Hand ClinicsCitation Excerpt :Carpal alignment can be measured by the radiolunate angle (normal −20 ± 15°), SL angle (normal 30–70°), and radioscaphoid angle (normal 35–65°). If dynamic instability is suspected, a clenched-pencil PA view provides a comparison of both wrists while loading the SL interval with grip force.41,42 A radiographic motion series can help evaluate the mobility and reduction potential of the carpus.
Ultrasonographic Classification of Scapholunate Interosseous Ligament Injury Associated With Distal Radius Fracture
2020, Journal of Hand Surgery
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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
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Reprint requests: Guy D. Foulkes, MD, Macon Orthopaedic and Hand Center, 840 Pine St, Suite 500, Macon, GA 31201.
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