{"title":"The Diagnostic Value of the Scapholunate C-Sign: A New Tool for Detecting Through-and-Through Scapholunate Interosseous Ligament Injuries.","authors":"Parunyu Vilai, Sanjeev Kakar","doi":"10.1016/j.jhsa.2025.06.011","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Currently, there is a lack of a validated clinical sign to accurately detect through-and-through or complete injuries to both the dorsal and volar scapholunate interosseous ligament. The aim of this study was to evaluate the validity of a clinical sign for detecting this condition.</p><p><strong>Methods: </strong>This study included 28 patients with suspected high-grade tears of the scapholunate interosseous ligament who underwent the C-sign maneuver. Each patient received a comprehensive evaluation, including a history, physical examination, magnetic resonance imaging interpretations by a musculoskeletal radiologist, and wrist arthroscopy. The diagnostic performance of the C-sign was assessed by calculating its sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, and overall accuracy, using wrist arthroscopy as the reference standard.</p><p><strong>Results: </strong>The C-sign, which includes both a characteristic patient reported symptom and a corresponding physical examination finding, demonstrated high sensitivity and specificity (86% and 83%, respectively) when present together. The positive likelihood ratio for the C-sign was 5.18, and the negative likelihood ratio was 0.16. The overall diagnostic accuracy was 85.7%. The diagnostic performance decreased when only one component of the C-sign was considered alone.</p><p><strong>Conclusions: </strong>The scapholunate C-sign is a valuable clinical indicator, demonstrating good diagnostic accuracy in detecting high-grade, through-and-through scapholunate interosseous ligament injuries that may warrant surgical intervention.</p><p><strong>Type of study/level of evidence: </strong>Diagnostic II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery-American Volume","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jhsa.2025.06.011","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Currently, there is a lack of a validated clinical sign to accurately detect through-and-through or complete injuries to both the dorsal and volar scapholunate interosseous ligament. The aim of this study was to evaluate the validity of a clinical sign for detecting this condition.
Methods: This study included 28 patients with suspected high-grade tears of the scapholunate interosseous ligament who underwent the C-sign maneuver. Each patient received a comprehensive evaluation, including a history, physical examination, magnetic resonance imaging interpretations by a musculoskeletal radiologist, and wrist arthroscopy. The diagnostic performance of the C-sign was assessed by calculating its sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, and overall accuracy, using wrist arthroscopy as the reference standard.
Results: The C-sign, which includes both a characteristic patient reported symptom and a corresponding physical examination finding, demonstrated high sensitivity and specificity (86% and 83%, respectively) when present together. The positive likelihood ratio for the C-sign was 5.18, and the negative likelihood ratio was 0.16. The overall diagnostic accuracy was 85.7%. The diagnostic performance decreased when only one component of the C-sign was considered alone.
Conclusions: The scapholunate C-sign is a valuable clinical indicator, demonstrating good diagnostic accuracy in detecting high-grade, through-and-through scapholunate interosseous ligament injuries that may warrant surgical intervention.
期刊介绍:
The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.