Scapholunate Ligamentous Communicating Defects in Symptomatic and Asymptomatic Wrists: Characteristics

Linkous, M. David; Pierce, Sean; Gilula, Louis A.

doi:10.1148/radiology.216.3.r00se15846

Cited by 55 publications

(29 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Linkous et al [24] hypothesized that the involvement of the fibrous dorsal segment produces symptomatic instability and that defects that extend into this segment (which, unlike the central segment contains nerve fibers) are more likely to be painful. The volar segment of the SLL is strengthened by the adjacent strong extracapsular volar extrinsic ligamentous complex and by the radioscapholunate ligament, which terminates at the junction of the volar and central segments of the SLL [4].…”

Section: Discussionmentioning

confidence: 99%

MR Arthrography of the Wrist: Controversies and Concepts

Maizlin¹,

Brown

Clement

et al. 2008

Hand (New York, N,Y.)

View full text Add to dashboard Cite

Magnetic resonance arthrography (MRA) has become the preferred modality for imaging patients with internal derangement of the wrist. However, several aspects of MRA use need to be clarified before a standardized approach to the imaging of internal derangement of the wrist can be developed. The objective of the study is to evaluate the efficiency of different magnetic resonance (MR) sequences in the detection of lesions of the triangular fibrocartilage complex (TFCC) and scapholunate and lunotriquetral ligaments on direct MRA. Thirty-one consecutive direct magnetic resonance arthrographic examinations of the wrist using a wrist surface coil were performed for the assessment of the TFCC and intrinsic ligaments on a 1.5-T MR imaging system (Signa; 16 channel, Excite, GE Healthcare, Milwaukee, WI, USA). All patients had wrist pain, and in six cases, there was associated clinical carpal instability. The presence, location, and extent of TFCC, scapholunate ligament (SLL), and lunotriquetral ligament (LTL) lesions on T1 fat-saturated, multiplanar gradient recalled (MPGR) and short tau inversion recovery (STIR) images were identified, compared, and analyzed. Forty-one lesions of the TFCC, SLL, and LTL were visualized on contrast-sensitive (T1 fat-saturated) images in 23/31 (74.2%) patients. Twenty-one lesions of the TFCC and intrinsic ligaments were visualized on noncontrast-sensitive (MPGR and STIR) images (15 tears of the TFCC and six tears of the SLL and LTL). All of these lesions were seen on T1 fat-saturated images; 48.8% (20/41) lesions seen on T1 fat-saturated images (eight tears of TFCC and 12 tears of SLL and LTT) were not seen on MPGR and/or STIR images. Superior contrast resolution, joint distention, and the flow of contrast facilitate the diagnosis of lesions of the TFCC and intrinsic ligaments on contrast-sensitive sequences making MRA the preferred modality for imaging internal derangements of the wrist. Little agreement exists regarding the value and location of perforations of the intrinsic ligaments given that both traumatic and degenerative perforations may be symptomatic. Noncommunicating defects of the ulnar attachments of the triangular fibrocartilage (TFC), tears of the dorsal segment of the SLL, and defects at the lunate attachment of the SLL have a higher likelihood of being symptomatic and caused by trauma rather than by degenerative perforation. Although no consensus exists, it would appear that most arthrographies should be started with a radiocarpal injection. Injection into the distal radioulnar joint should be added if no communicational defects are visualized following radiocarpal injection in patients with ulnar-sided wrist pain.

show abstract

Section: Discussionmentioning

confidence: 99%

MR Arthrography of the Wrist: Controversies and Concepts

Maizlin¹,

Brown

Clement

et al. 2008

Hand (New York, N,Y.)

View full text Add to dashboard Cite

show abstract

“…Because the patient usually knows best which movement provokes a dynamic snap, the patient should be requested to actively perform the instability maneuver during kinematographic documentation. The three-compartment arthrographic approach is recommended to precisely visualize uni-or bidirectional passages of the dye across ligamentary defect zones [44,45]. In the classic technique, the contrast agent is firstly injected into the midcarpal and distal radioulnar joints under fluoroscopic control, followed by the arthrography of the radiocarpal joint two hours later.…”

Section: Kinematography (Cr)mentioning

confidence: 99%

“…A modified procedure uses an adhesive marker-plate with radiopaque coordinates for simple puncture guidance [46]. Wrist arthrography enables the detection of communication defects with high sensitivity [45], but hampers from low specificity rates due to the inability to differentiate nonsymptomatic central defects from lesions of the peripheral ligament segments [44].…”

Section: Kinematography (Cr)mentioning

confidence: 99%

“…In mostly asymptomatic individuals, they sufficiently explain uni-or even bidirectional communication defects. In the elderly patient population, there is only a loose correlation between clinical and arthrographic findings [45,48]. Therefore, it is recommened to combine wrist arthrography with a subsequent magnetic resonance imaging (MRI) or computed tomography (CT) examination [47,[49][50][51][52] to better assess the altered ligament segments (Figs.…”

Section: Kinematography (Cr)mentioning

confidence: 99%

See 1 more Smart Citation

Carpal instability

et al. 2006

View full text Add to dashboard Cite

This review addresses the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist. Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated. Instability occurs either if the carpus is unable to sustain physiologic loads ("dyskinetics") or suffers from abnormal motion of its bones during movement ("dyskinematics"). In the classification of carpal instability, dissociative subcategories (located within proximal carpal row) are differentiated from non-dissociative subcategories (present between the carpal rows) and combined patterns. It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being "occult" for the radiologic assessment. This paper emphasizes the high utility of kinematographic studies, contrast-enhanced magnetic resonance imaging (MRI) and MR arthrography for detecting these predynamic and dynamic instability stages. Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability. To prevent individual and socio-economic implications, the hand surgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis.

show abstract

“…10,16 The interpretation of such ligament defects relies heavily on the clinical context as asymptomatic perforations or degenerative tears are common. 1,17,18 It is always dangerous to routinely perform a MR imaging investigation hopefully searching for abnormality or with a clinical request of 'wrist pain'. Interaction with a specialised practitioner should result in tailoring of the MR examination to confirm or grade a clinically suspected injury and identify any other significant concomitant injuries.…”

Section: Scapholunate Ligamentmentioning

confidence: 99%