(2010). This burst causes the scaphoid bone to dorsally rotate. Frankel in 1977, likened the widening of the scapholunate interval to the ‘upper central dental diastema‘ of British comedian Terry-Thomas 1. For newer radiology students who do not know who Terry-Thomas was, this finding might also be known as the David Letterman sign. In radiology, the Terry Thomas sign is a scapholunate ligament dissociation on an anteroposterior view of the wrist. A gap of more than 3mm is pathognomonic for scapholunate dissociation. Longdom Publishing, C/ Sant Gil 3, 2-3, 08001 Barcelona, Spain. On the PA view- the “Terry-Thomas” sign caused by widening of the scapholunate space (normal, <3 mm), the cortical ring sign caused by the abnormally flexed scaphoid creating a double density, and an abnormally triangular shaped lunate. In radiology, the Terry Thomas sign is a scapholunate ligament dissociation on an anteroposterior view of the wrist. Terry Thomas Sign (AKA David Letterman sign) Increased scapholunate joint space when compared to contralateral side; Any asymmetric gap measuring greater than 5 mm is diagnostic of SLD. The increased distance indicates scapholunate dissociation (often with rotary subluxation of the scaphoid) due to ligamentous injury. 1996 Mar;21(2):170-8. J Hand Surg Am. dorsal tilt of lunate leads to SL angle > 70 ° on neutral rotation lateral ; capitolunate angle > 20° DISI . #FOAMed Medical Education Resources by LITFL is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. (129): 321-2. Terry-Thomas gave permission for his name to be used. More than 2 mm The “Terry-Thomas” sign is generally the most readily distinguished abnormality on plain radiographs in this injury pattern. An otherwise fit and well 35 year old gentleman presented with a several month history of radial sided wrist pain after a fall onto an outstretched hand. The Terry-Thomas sign. Synonym(s): Lauren Hutton sign; Terry Thomas sign In more modern times, the monikers David Letterman or Madonna have also been used for the sign, not least because many younger clinicians have never heard of Terry-Thomas. [. The increased distance indicates scapholunate dissociation (often with rotary subluxation of the scaphoid) due to ligamentous injury. Dental diastema (the classic Terry-Thomas dental pattern) is a useful anthropomorphic sign for detecting rotatory luxation of the navicular (scaphoid).‘ – Frankel VH, Dr. Frankel graciously obtained the actor’s permission before naming a pathological entity after him. The gap in his upper teeth is so famous that in British medicine there is a Terry-Thomas sign - the gap between the scaphoid and lunate bones (scapho-lunate disassociation) on x-rays. Frankel VH. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers.

[3] A gap of more than 3mm is pathognomonic for scapholunate dissociation. The increased distance indicates scapholunate dissociation, which is usually even more clearly observed on a lateral radiograph. The patient failed a period of nonoperative treatment and went on to have delayed reconstruction of the scapholunate ligament via a modified Brunelli procedure and did well. Asynchronous learning #FOAMed evangelist. [1][2] Most commonly a result of a fall on the outstretched hand (FOOSH), the scapholunate ligament ruptures resulting in separation of the lunate and scaphoid bones. [4], The resulting separation between the scaphoid and lunate bones leaves a space on the x-ray that is similar to the gap comedian Terry-Thomas had between his front teeth. Its name derives from, This page was last edited on 18 September 2019, at 10:54. In radiology, the Terry Thomas sign is a scapholunate ligament dissociation on an anteroposterior view of the wrist. Unable to process the form. Can J Surg. Can J Surg.

Widening of the scapholunate space (Terry Thomas sign). Case 5: scapholunate advanced collapse (SLAC). [, Linscheid RL, Dobyns JH, Beabout JW, Bryan RS.

SLI is diagnosed with a gap or separation between the scaphoid and the lunate bones on a posterior anterior wrist X-ra y. In the same paper Frankel described the mnemonic for bones of the carpus as ‘Never Lower Tillie’s Pants, Grandma May Come Home.‘ – this may appear confusing…until modern nomenclature is applied, Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Scapholunate ligament injury: the natural history. In radiology, the Terry Thomas sign is a scapholunate ligament dissociation on an anteroposterior view of the wrist. The gap between the scaphoid bone and lunate bone that occurs when there is a traumatic ligamentous disruption has been named after Mr. Thomas in … Scapholunate dissociation is associated with scapholunate ligament disruption; scaphoid subluxation, rotation and p… They revealed the four typical radiological signs for scapholunate disruption. Most commonly a result of a fall on the outstretched hand (FOOSH), the scapholunate ligament ruptures resulting in separation of the lunate and scaphoid bones. Specialised tests for the scapholunate ligament- the Kirk Watson scaphoid shift test and the scapholunate ballottement test were positive.



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