to scan the scalinate ligament. Again, the patient is seated like this, but the hand is now placed over a gel bottle, a bolster, something like that, a towel. Uh, so the hand is in a relative palm of flexion. Uh, I'm going to place the uh, transducer again on top of Lissa's tubicle. So, Lissa's tubicle you can see uh, right there. Then from here on, we're going to slide to distal. So you can see the bone uh changing until uh we see the uh scaffoid bone right there and the lunate bone right here. In between the lunate and the scaffoid bone we can see the scaffo lunate uh joint with also the scafolunate ligament which is the hypercoic tissue right there. In case of a ligament tear then you will or you maybe you won't see the ligament or you see a ligament which also contains a tear which will show itself uh anacoic. Uh but the best way to test this scafalunate stability and ligament is by placing the patient's hand into a er deviation and after this ulnar deviation we're going to ask the patient to clench the fist slowly. So the patient is now clenching the fist and please let go. Yeah, like this. And let's clench again the fist. And now we observing the joint width, the the degree of gapping, the degree of instability between the lunate and the scaffoid bone. Okay. And relax again. If there is a instability then you will see clearly that these two bones go apart that the joint width will become larger that there is gapping and you will also see yeah opening of uh the ligament in the depth by the way we can see see some bubbles that come from the joint. So this is a normal feature but this might be more apparent in case of a scaffoid ligament lesion.
