Shenton's Line of the Wrist
Jonathan B Slaughter, MD; Chris Casstevens, MD; Peter J. Stern, MD
University of Cincinnati, Cincinnati, OH
Xrays are a key component of a hand surgeon's evaluation of a patient. Lateral xrays of the wrist are used looking at bony definition, alignment, and evaluation for carpal static stability. We have notice on true lateral xrays (pisiform overlies the volar capitate head and scaphoid tuberosity), there is a smooth transition or "arc" (Shenton's line of the wrist) created by the volar surface of the radial styloid and volar surface of the waist and tuberosity of the scaphoid. We wanted to determine if this smooth "arc" or line" is consistently present on true lateral xrays of uninjured wrists. If this line is consistently present on uninjured wrists and disrupted on injured wrists/wrists with carpal instability, it can be used as a guide for treatment and possible diagnosis during office examinations similar to Maloney's line in the shoulder and Shenton's line in the hip. To the best of our knowledge, this "arc" or "line" has not previously been described in the literature.
A retrospective review was performed by searching Centricity for wrist xrays that were performed since January 2016 to identify uninjured (No prior fracture or prior surgery)wrist xrays. Next, a review of proximal row carpectomy surgeries performed since April 2013 was performed to identify preoperative wrist xrays of patients with scapholunate advanced collapse. Only true lateral xrays (pisiform overlies the volar capitate head and scaphoid tuberosity) were included in the study. The xrays were then evaluated for the presence or absence of "Shenton's line" and measurements of the scapholunate angle, capitolunate angle, and scapholunate interval were recorded.
A total of 106 uninjured wrist xrays and 50 SLAC wrist xrays were evaluated. The uninjured wrists had an average age of 52.9 years, and the SLAC wrists had an average age of 66.8 years. Shenton's line was present in 103/106 (97.2%) in the uninjured group, and present in 10/50 (20%) in the SLAC group (p<0.001). Shenton's line had a 93% positive predictive value and 91% negative predictive value for carpal malalignment.
In normal, uninjured wrists, the scaphoid tuberosity and radial styloid form a consistent arc/line on neutral rotation, true lateral xrays. If this line is disrupted, there is a high likelihood the patient has carpal malalignment.
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