Dorsal intercalated segment instability

Last revised by Joshua Yap on 28 Nov 2024

Dorsal intercalated segment instability (DISI) is a form of carpal instability featuring dorsal tilt of the lunate. It occurs mainly after the disruption of the scapholunate ligament and is more often encountered than volar intercalated segment instability (VISI).

  • radial or dorsal wrist pain, maximal on radial deviation and wrist extension

  • weakness and/or instability

  • clicking wrist

  • positive Watson test: during ulnar to radial deviation, pressure applied to the volar aspect of the scaphoid elicits an audible and/or palpable clunk (due to dorsal subluxation of the scaphoid with respect to the radius)

Fixed DISI deformity only occurs after combined injury of scapholunate ligament and other stabilizers of the scaphoid, namely radioscaphocapitate and scaphocapitate ligaments.

On an AP view, the normal trapezoidal configuration of the scaphoid may be lost and it may appear triangular.

On the lateral radiograph with the wrist in a neutral position, DISI typically demonstrates dorsal tilt of the lunate with both of the following present:

On sagittal CT, the same findings as on lateral radiographs are seen.

On sagittal MRI 9, the same findings as on plain radiograph are seen. However, bone contusion, scaphoid osteonecrosis, and scapholunate ligament injury are evaluated with more precision.

Cases and figures

  • Figure 1: DISI
  • Figure 2: scapholunate angle
  • Figure 3: capitolunate angle
  • Figure 4: scapholunate angle
  • Figure 5: capitolunate angle
  • Case 1
  • Case 2: following scaphoid fracture
  • Case 4
  • Case 3
  • Case 5
  • Case 6
  • Case 7: treated with proximal row carpectomy
  • Case 8
  • Case 9
  • Case 10
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