THE X-FILES THE X-FILES The “Terry Thomas” sign A BY DR. MARSHALL DELTOFF, DC colleague in Bermuda sent this case to me. A 47-year old male presented expe-riencing right wrist pain over the scapholunate joint after jamming it in extension while playing ice hockey. It is a very sharp pain and there is swelling over the area. He is having sharp pain with gripping or rotation. DIAGNOSIS: DR. MARSHALL DELTOFF, DACBR, FCCR(C), FEAC, is a Professor of Radiology at Barcelona College of Chiropractic. He offers an online X-ray reporting service for colleagues across Canada and can be reached at: [email protected]. He is also offers live interactive CE zoom webinars for your association or local society. 22 Chiropractic and Naturopathic Doctor September/October 2022 Visit cndoctor.ca for more case reports like these. www.Cndoctor.ca Photo: Westend61/Adobe stock Rupture of the scapho-lunate ligament, resulting in the “Terry Thomas” sign (arrow). The increased distance indi-cates scapholunate dissociation and often can be associated with rotary subluxation of the scaphoid. The sign is named after well-known British comic Terry Thomas. Terry Thomas (1911 – 1990) had a large gap between his two front teeth [front den-tal diastema] and this made his smile very peculiar. Scapholunate dissocia-tion is a wrist injury that occurs due to falling on an outstretched hand or FOOSH injury. The rupture of the scapholunate ligament leads to separation of the lu-nate and scaphoid bones. The injury also causes rotation of scaphoid bone. Most authorities agree that a gap of 3-4 mm is diagnostic in most cases. In fact, a gap of more than 3mm is pathogno-monic for scapholunate dissociation by some authors. For newer students who do not know who Terry Thomas was, this finding might also be known as the David Letterman sign, or the Madonna sign because both of these celebrities also have dental front diastema. But their gap is not as big and as classic as Terry’s. Above: Rupture of the scapho-lunate ligament, resulting in the “Terry Thomas” sign. Left: An example of dental front diastema.
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