Extrinsic and Intrinsic Ligaments of the Wrist

Abstract

Carpal stability depends on the integrity of both intra-articular and intracapsular carpal ligaments. In this review, the role of the radial-sided and ulnar-sided extrinsic and intrinsic ligaments is described, as well as their advanced imaging using magnetic resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI) with three-dimensional (3D) scapholunate complex sequences and thin slices. In the last decade, the new concept of a so-called “scapholunate complex” has emerged among hand surgeons, just as the triangular ligament became known as the triangular fibrocartilage complex (TFCC).The scapholunate ligament complex comprises the intrinsic scapholunate (SL), the extrinsic palmar radiocarpal: radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate (SRL) ligaments, the extrinsic dorsal radiocarpal (DRC) ligament, the dorsal intercarpal (DIC) ligament, as well as the dorsal capsular scapholunate septum (DCSS), a more recently described anatomical structure, and the intrinsic palmar midcarpal scaphotrapeziotrapezoid (STT) ligament complex. The scapholunate (SL) ligament complex is one of the most involved in wrist injuries. Its stability depends on primary (SL ligament) and secondary (RSC, DRC, DIC, STT ligaments) stabilizers.The gold standard for carpal ligament assessment is still diagnostic arthroscopy for many hand surgeons. To avoid surgery as a diagnostic procedure, advanced MRI is needed to detect associated lesions (sprains, midsubstance tears, avulsions and chronic fibrous infiltrations) of the extrinsic, midcarpal and intrinsic wrist ligaments, which are demonstrated in this article using 3D and two-dimensional sequences with thin slices (0.4 and 2 mm thick, respectively).

Clinical Study of Wrist Arthroscopy Combined with Oblique Ulnar Shortening Osteotomy in the Treatment of Ulnar Impaction Syndrome

“…(i) Oblique osteotomy can achieve ulnar neutral or negative variation, reduce the pressure of ulna on the wrist, and tighten TFCC to stabilize the lower radioulnar joint, and the study confirmed that oblique osteotomy can obtain a shorter healing time and lower complication rate than transverse osteotomy 26 ; (ii) Because the ulna will change in the process of rotation, for some patients whose ulna positive variation is not obvious on orthopaedic X‐ray film, wrist arthroscopy can directly observe the ulna variation in the process of rotation to make a clear diagnosis of the disease and the degree of injury and then choose the best operation plan 27 ; (iii) Wrist arthroscopy can clean up the proliferative synovial tissue and free articular cartilage and repair the TFCC injury to effectively improve the symptoms and restore wrist function; (iv) Wrist arthroscopy has the advantage of being minimally invasive, which can ensure minimal injury in the joint at the time of treatment, is helpful for the rehabilitation of patients, and has the advantages of a low complication rate and quick postoperative recovery 22 .…”

Diagnostic performance of high-resolution ultrasound in the evaluation of intrinsic and extrinsic wrist ligaments after trauma

“…Imaging helps in diagnosis, including X-rays assessment of bone structures as firstlevel and magnetic resonance imaging, computed tomography arthrography or magnetic resonance arthrography (MRA) as second-level modalities [5][6][7]. Particularly, MRA is the best imaging method to visualize wrist ligament and assess related injuries [6,7], although it is expensive and often unavailable in the setting of acute trauma. Preliminary results have been published on ultrasound (US) of wrist ligaments, which is cost-effective, non-invasive and largely available [8][9][10][11][12][13].…”

“…Early diagnosis and prompt treatment are of paramount importance to prevent long-term complications. Imaging, including X-ray assessment of bone structures as first-level and magnetic resonance imaging, computed tomography arthrography, or magnetic resonance arthrography (MRA) as second-level modalities, helps with diagnosis [5,6,7]. Particularly, MRA is the best imaging method to visualize wrist ligaments and assess related injuries [6,7], although it is expensive and often unavailable in the setting of acute trauma.…”