Both the aetiology and natural history of scapholunate (SL) interval widening are poorly understood, as is the risk of progression into carpal instability and scapholunate advanced collapse (SLAC wrist), with its classic pattern of arthritic change. When a patient with a painful wrist presents after trauma with a widened scapholunate interval, the natural assumption is that this represents an acute rupture; however, this may not be the case. It is widely recognized that the con-tralateral wrist can have the same abnormality. While the causes for this are unclear, other conditions such as ligamentous laxity and degenerative change are thought usually to be responsible. This study from Ghent (Belgium) sought to examine the prevalence of bilateral widened SL intervals in the absence of trauma, and to investigate if atraumatic SL interval widening would lead to instability and degenerative change.1 The authors identified and reviewed 1000 radiographs of patients who attended clinic or were hospitalized for a hand or wrist problem over a four-year period. These patients all had bilateral radiographs, as the author's routine practice is to also image the con-tralateral hand simultaneously. Indication for radiographs, sex, age, and the presence of osteoarthritic change were recorded.
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