Carpal Biomechanics: Application to Ligamentous Injuries

Camus, Emmanuel

doi:10.1007/978-2-8178-0379-1_2

Cited by 5 publications

(15 citation statements)

References 63 publications

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“…According to Sennwald, the pTS ligament avoids palmar triquetroscaphoid dissociation and, indirectly, scapholunate dissociation. It maintains the proximal part of the capitate when the wrist extends [52]. The ligament is extra-articular and not directly accessible to arthroscopic examination.…”

Section: Intrinsic Ligamentsmentioning

confidence: 98%

Advanced imaging of the scapholunate ligamentous complex

et al. 2015

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The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies.

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Section: Intrinsic Ligamentsmentioning

confidence: 98%

Advanced imaging of the scapholunate ligamentous complex

et al. 2015

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“…connect two nonadjacent carpal bones. To facilitate understanding of the pathologies, the ligaments have been subdivided in five groups: 6,16 -Palmar radiocarpal ligaments: RSC, RLT (LRL, SRL), RSL -Ulnocarpal ligaments: UL, UT (palmar and dorsal) -Dorsal radiocarpal ligament: dorsal RC (or RLT) -Midcarpal ligaments: dorsal IC (dorsal TS, TTT) and palmar TS…”

Section: Arthroscopymentioning

confidence: 99%

“…The palmar ligaments are the most important stabilizers of wrist motion, and injury of these ligaments can produce chronic wrist pain and disability. 6,12 They limit ulnar deviation and dorsal flexion and maintain the position of the scaphoid bone. 22 All radiocarpal ligaments have a proximal origin at the distal end of the radius and a distal insertion at the level of one or more carpal bones.…”

Section: Palmar Radiocarpal Ligamentsmentioning

confidence: 99%

“…13). It forms the dorsal component of the Khulman sling 6,16 and is a secondary stabilizer of the carpal bones. 32,46 The dorsal RLT limits intracarpal supination, radial deviation, palmar flexion, and ulnar translation of the carpal bones.…”

Section: Dorsal Radiocarpal and Midcarpal Ligamentsmentioning

confidence: 99%

“…4 Most authors agree that with carpal instability, lesions of intrinsic but also extrinsic ligaments are present. 5,6 However, to develop significant carpal instability, the interosseous scapholunate and lunotriquetral ligaments have to be damaged. Although treatment of these conditions may be difficult, early diagnosis is imperative for a good result.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Pathology of Extrinsic Ligaments: A Pictorial Essay

Shahabpour

Overstraeten

Ceuterick

et al. 2012

Semin Musculoskelet Radiol

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The role of the extrinsic ligaments, together with the intrinsic ligaments, appears to be much more important than previously thought in the setting of carpal stability. The anatomy and pathology of the extrinsic wrist ligaments is complex. Magnetic resonance imaging (MRI) with thin slices is essential for visualization. This article describes the pathological appearance of the extrinsic palmar and dorsal radiocarpal and ulnocarpal ligaments on MRI, correlated with arthroscopy (performed by two skilled hand surgeons), clinical findings, and follow-up. High-resolution MRI, especially using isotropic three-dimensional sequences with orthogonal multiplanar reconstructions on 3T MR systems, allows detailed depiction of many of the extrinsic ligaments affected in carpal injuries. Recognition of ligament abnormalities is improved by intra-articular or intravenous injection of contrast before the examination. Both techniques may help to determine the precise localization, size, and extent of dorsal and palmar radiocarpal and ulnocarpal ligament lesions. Further experience with these techniques is needed to define the place of MRI in the management of traumatic wrist injuries.

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