2. Clinical examination revealed swelling and tenderness most pronounced dorsally just distal to Lister’s tubercle in the region of the scapholunate ligament. In radiology, the Terry Thomas sign is a scapholunate ligament dissociation on an anteroposterior view of the wrist.

Widening of the scapholunate space (Terry Thomas sign). Terry Thomas sign; Arrow pointing to the gap between scaphoid and lunate bones.

Neill A. Anatomy for Emergency Medicine 018: Clark DL, von Schroeder HP. Can J Surg. For newer radiology students who do not know who Terry-Thomas was, this finding might also be known as the David Letterman sign.
These two bones are in the human wrist.

Check for errors and try again. Frankel in 1977, likened the widening of the scapholunate interval to the ‘upper central dental diastema‘ of British comedian Terry-Thomas, 1977 – Victor H Frankel, MD proposed and sought permission from the actor Terry-Thomas that his name and physiognomy be used eponymously, ‘The application of anthropomorphic similes can aid in the recognition of conditions that are difficult to diagnose and easily overlooked.

1. weakness of grip and a clicking sensation in the wrist. #FOAMed Medical Education Resources by LITFL is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

The sign is named after the famous British comic from the 1950’s who had a trademark gap between his two front teeth / frontal dental diastema.

Unable to process the form. Can J Surg. [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. SLI is diagnosed with a gap or separation between the scaphoid and the lunate bones on a posterior anterior wrist X-ra y. Thomas Terry Hoar Stevens, dit Terry-Thomas, né le 14 juillet 1911 à Londres (quartier de Finchley), et mort le 8 janvier 1990 à Godalming dans le Surrey, est un acteur britannique. [3] A gap of more than 3mm is pathognomonic for scapholunate dissociation. Wonders of Radiology. Frankel in 1977, likened the widening of the scapholunate interval to the ‘upper central dental diastema‘ of British comedian Terry-Thomas 1. Learn how your comment data is processed.

Res. This burst causes the scaphoid bone to dorsally rotate. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers.

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Case 5: scapholunate advanced collapse (SLAC). Check for errors and try again. Specialised tests for the scapholunate ligament- the Kirk Watson scaphoid shift test and the scapholunate ballottement test were positive. [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. In patients with SLD, the scaphoid is flexed leading to shortened appearance on the PA view, there may be the cortical ring sign on the PA view due end on view of distal pole. The Terry-Thomas sign.

A gap of more than 3mm is pathognomonic for scapholunate dissociation. (129): 321-2. 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 dissociation - Terry Thomas sign. Relat. J Bone Joint Surg Am. Clark DL, von Schroeder HP.

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. 3. Terry Thomas. The comedian added the hyphen between his two names as he disliked being called Mr. Thomas, and it was more distinctive 3.

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The “Terry-Thomas” sign is generally the most readily distinguished abnormality on plain radiographs in this injury pattern. The Terry Thomas (or Madonna) sign is given to the increase in the scapholunate space identified on an AP radiograph. Terry-Thomas gave permission for his name to be used. Terry Thomas sign The Terry Thomas sign refers to an increase in the scapholunate space on an AP radiograph of the wrist (or coronal CT). 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 gap between the scaphoid bone and lunate bone that occurs when there is a traumatic ligamentous disruption has been named after Mr. Thomas in … The increased distance indicates scapholunate dissociation, which is usually even more clearly observed on a lateral radiograph. Widening of the scapho-lunate gap (Terry Thomas sign – named after the actor with a large gap in his front teeth) The ‘ring sign’ on the the scaphoid MRI scan which can show the actual ligament tear and swelling Wrist arthroscopy (keyhole surgery) which can allow the ligament to be visualized in real time. The increased distance indicates scapholunate dissociation. [, Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Its name derives from, This page was last edited on 18 September 2019, at 10:54. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Terry-Thomas Sign: increased distance between the scaphoid and the lunate (scapholunate space) on AP XR of the wrist associated with scapholunate dissociation.


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.

Its name derives from Terry-Thomas, who had a similar looking gap between his two front teeth: Differential diagnosis: scapholunate ligament dissociation: 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. The increased distance indicates scapholunate dissociation (often with rotary subluxation of the scaphoid) due to ligamentous injury. Longdom Publishing, C/ Sant Gil 3, 2-3, 08001 Barcelona, Spain. [3], Last edited on 18 September 2019, at 10:54, https://en.wikipedia.org/w/index.php?title=Terry_Thomas_sign&oldid=916332567, Creative Commons Attribution-ShareAlike License, Arrow pointing to the gap between scaphoid and lunate bones. David Letterman sign - on plain film of the wrist, subluxation of scaphoid bone resulting in widening of space between scaphoid and lunate carpal bones; so called because it is similar to prominent gap between central front teeth in this television personality. Clin Orthop Relat Res. Frankel VH. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |. ADVERTISEMENT: Supporters see fewers/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Based on a work at https://litfl.com, Negotiating Autonomy at the Point of Care, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, Scapholunate dissociation is associated with scapholunate ligament disruption; scaphoid subluxation, rotation and potential carpus instability, The scapholunate interval (measured at the midpoint of the adjacent parallel articular contours of the scaphoid and lunate bones) should be <2mm and scapholunate dissociation (Terry-Thomas sign) most commonly described for intervals >4mm, With scapholunate dissociation, the scaphoid often rotates to a more transverse position increasing the scapholunate angle to more than 60° and if rotated to be viewed end-on the ‘, Frankel VH. (2010).

{"url":"/signup-modal-props.json?lang=us\u0026email="}. For immediate assistance, contact Customer Service: 800-638-3030 (within the USA), 301-223-2300 (outside of the USA) customerservice@lww.com Synonym(s): Lauren Hutton sign; Terry Thomas sign Traumatic instability of the wrist. In radiology, the Terry Thomas sign is a scapholunate ligament dissociation on an anteroposterior view of the wrist.

Diagnosis, classification, and pathomechanics.

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. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":10013,"mcqUrl":"https://radiopaedia.org/articles/terry-thomas-sign-4/questions/1710?lang=us"}. Scapholunate ligament injury: the natural history. Z. V. Maizlin. Scapholunate ligament injury: the natural history. In radiology, the Terry Thomas sign is a scapholunate ligament dissociation on an anteroposterior view of the wrist.

Synonym(s): Lauren Hutton sign; Terry Thomas sign Most commonly a result of a fall on the outstretched hand (), the scapholunate ligament ruptures resulting in separation of the lunate and scaphoid bones.This burst causes the scaphoid bone to dorsally rotate. [3] A gap of more than 3mm is pathognomonic for scapholunate dissociation.

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