Pirela-Cruz MA, Orthopaedic Surgery Department, Texas Tech Medical Center, 4801 Alberta Avenue, El Paso, TX, USA
The scaphoid cortical ring sign (CRS) has been identified as a radiological indicator of ligamentous injury of the wrist. It has been associated with some pathokinomatic states. There exists a range of wrist positions where the CRS may be normally present. The purpose of this study is to define the range of motion when the CRS can be normally observed on a standard PA radiograph, and in turn, define the range when the CRS is not expected to be present. One hundred and nine posteroanterior radiographs of normal wrists were evaluated for the presence, partial presence and absence of the scaphoid CRS. The results were correlated with the radio-metacarpal (RM) angle in neutral palmar-dorsiflexion of the wrist. The range of wrist deviation for the wrists studied was –10.0 (radial deviation) to 23.0 (ulnar deviation). Results: We defined the normal (and abnormal) range as being two standard deviations from the mean. The CRS was present in 25% of the radiographs evaluated. Moreover, the CRS was found to be present at 2.7 (+/-7.7) degrees of radial deviation with an expected range of 18.1 degrees of radial deviation to 12.7 degrees of ulnar deviation. The ring sign was absent at 12.4 (+/-11.7) degrees of ulnar deviation. Conclusion: CRS observed at values less than 13 degrees of ulnar deviation may or may not be abnormal. If the CRS is observed at a RM angle of 13 degrees of ulnar deviation or greater, it should be considered pathologic. The CRS, however, should be used in conjunction with other clinical and radiological findings of carpal instability.