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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