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Table 4 Case Report Form

From: ACTION trial: a prospective study on diagnostic Accuracy of 4D CT for diagnosing Instable ScaphOlunate DissociatioN

Patient-ID:  
Screening: Date
 Suspected SLL tear Yes No
 Indication for arthroscopy Yes No
 > 18 Years Yes No
 Ability to perform radio-ulnar motion Yes No
 Written informed consent Yes No
Exclusion criteria: Date
 Pregnancy Yes No
Incompliance for radio-ulnar motion
 SLAC Yes No
Enrolment: Date
 Date of enrolment  
Epidemiology:
 Gender Male Female
 Side of injury Right Left
 Handedness Right Left
 Date of injury  
 Age at the day of injury  
Clinical examination: Date
 Watson-Test Positive Negative
 Localized pain during compression of dorsal SLL Yes No
Arthroscopy: Date
 Age at the day of arthroscopy  
 EWAS/Geissler Stadium  
 Stability Stable Unstable