PDF herunterladen
Semin Musculoskelet Radiol 2021; 25(02): 311-328
DOI: 10.1055/s-0041-1731653
Review Article

Extrinsic and Intrinsic Ligaments of the Wrist

Maryam Shahabpour
1   Department of Radiology, Universitair Ziekenhuis Brussel (Vrije Universiteit Brussel), Brussels, Belgium
,
Wiem Abid
1   Department of Radiology, Universitair Ziekenhuis Brussel (Vrije Universiteit Brussel), Brussels, Belgium
,
Luc Van Overstraeten
2   Hand and Foot Surgery Unit, Tournai and Department of Hand Surgery, Hôpital Universitaire Erasme, Brussels, Belgium
,
Kjell Van Royen
3   Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (VUB), Brussels, Belgium
,
Michel De Maeseneer
1   Department of Radiology, Universitair Ziekenhuis Brussel (Vrije Universiteit Brussel), Brussels, Belgium
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

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).

Keywords

scapholunate complex - extrinsic and intrinsic wrist ligament tears - carpal instability - 3D magnetic resonance imaging and arthrography

Supplementary Material



Publikationsverlauf

Artikel online veröffentlicht:
09. August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Feipel V, Rooze M. The capsular ligaments of the wrist: morphology, morphometry and clinical applications. Surg Radiol Anat 1999; 21 (03) 175-180
    CrossrefPubMedGoogle Scholar
  • 2 Schmitt R, Froehner S, Coblenz G, Christopoulos G. Carpal instability. Eur Radiol 2006; 16 (10) 2161-2178
    CrossrefPubMedGoogle Scholar
  • 3 Dautel G. Normal wrist arthroscopy. In: Camus E, Van Overstraeten L. eds. Ligamentous Surgery of the Wrist. Berlin, Germany: Springer; 2013: 99-107
    Google Scholar
  • 4 Theumann NH, Etechami G, Duvoisin B. et al. Association between extrinsic and intrinsic carpal ligament injuries at MR arthrography and carpal instability at radiography: initial observations. Radiology 2006; 238 (03) 950-957
    CrossrefPubMedGoogle Scholar
  • 5 Camus E. Carpal biomechanics: application to ligamentous injuries. In: Camus E, Van Overstraeten L. eds. Carpal Ligament Surgery. Paris, France: Springer; 2013: 19-37
    CrossrefGoogle Scholar
  • 6 Van Overstraeten L. Arthroscopic anatomy and lesions of the extrinsic ligaments. In: Camus E, Van Overstraeten L. eds. Carpal Ligament Surgery. Paris, France: Springer; 2013: 119-131
    CrossrefGoogle Scholar
  • 7 Van Overstraeten L, Camus EJ. A systematic method of arthroscopic testing of extrinsic carpal ligaments: implication in carpal stability. Tech Hand Up Extrem Surg 2013; 17 (04) 202-206
    CrossrefPubMedGoogle Scholar
  • 8 Van Overstraeten L, Camus EJ. The role of extrinsic ligaments in maintaining carpal stability—a prospective statistical analysis of 85 arthroscopic cases. Hand Surg Rehabil 2016; 35 (01) 10-15
    CrossrefPubMedGoogle Scholar
  • 9 Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 1972; 54 (08) 1612-1632
    CrossrefPubMedGoogle Scholar
  • 10 Grunz JP, Gietzen CH, Grunz K, Bley T, Schmitt R. Imaging of carpal instabilities. Röfo Fortschr Geb Röntgenstr Nuklearmed 2021; 193 (02) 139-150
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Garcia-Elias M. The non-dissociative clunking wrist: a personal view. J Hand Surg Eur Vol 2008; 33 (06) 698-711
    CrossrefPubMedGoogle Scholar
  • 12 Viegas SF, Patterson RM, Ward K. Extrinsic wrist ligaments in the pathomechanics of ulnar translation instability. J Hand Surg Am 1995; 20 (02) 312-318
    CrossrefPubMedGoogle Scholar
  • 13 Viegas SF, Patterson RM, Hokanson JA, Davis J. Wrist anatomy: incidence, distribution, and correlation of anatomic variations, tears, and arthrosis. J Hand Surg Am 1993; 18 (03) 463-475
    CrossrefPubMedGoogle Scholar
  • 14 Overstraeten LV, Camus EJ, Wahegaonkar A. et al. Anatomical description of the dorsal capsulo-scapholunate septum (DCSS). Arthroscopic staging of scapholunate instability after DCSS sectioning. J Wrist Surg 2013; 2 (02) 149-154
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 15 Shahabpour M, Staelens B, Van Overstraeten L. et al. Advanced imaging of the scapholunate ligamentous complex. Skeletal Radiol 2015; 44 (12) 1709-1725
    CrossrefPubMedGoogle Scholar
  • 16 Shahabpour M, Van Overstraeten L, De Maeseneer M. Anatomy and injuries of the extrinsic and midcarpal ligaments. In: Shahabpour et al, eds. MRI Wrist and Hand. Vienna, Austria: Breitenseher; 2021: 113-132
    Google Scholar
  • 17 Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am 2007; 32 (03) 297-309
    CrossrefPubMedGoogle Scholar
  • 18 Berger RA. The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop Relat Res 2001; (383) 32-40
    CrossrefPubMedGoogle Scholar
  • 19 Berger RA. The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 1996; 21 (02) 170-178
    CrossrefPubMedGoogle Scholar
  • 20 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: Part II. J Hand Surg Am 2005; 30 (01) 24-34
    CrossrefPubMedGoogle Scholar
  • 21 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am 2002; 27 (06) 991-1002
    CrossrefPubMedGoogle Scholar
  • 22 Burns JE, Tanaka T, Ueno T, Nakamura T, Yoshioka H. Pitfalls that may mimic injuries of the triangular fibrocartilage and proximal intrinsic wrist ligaments at MR imaging. Radiographics 2011; 31 (01) 63-78
    CrossrefPubMedGoogle Scholar
  • 23 Totterman SM, Miller R, Wasserman B, Blebea JS, Rubens DJ. Intrinsic and extrinsic carpal ligaments: evaluation by three-dimensional Fourier transform MR imaging. AJR Am J Roentgenol 1993; 160 (01) 117-123
    CrossrefPubMedGoogle Scholar
  • 24 Rominger MB, Bernreuter WK, Kenney PJ, Lee DH. MR imaging of anatomy and tears of wrist ligaments. Radiographics 1993; 13 (06) 1233-1246 ; discussion 1247–1248
    CrossrefPubMedGoogle Scholar
  • 25 Cerezal L, de Dios Berná-Mestre J, Canga A. et al. MR and CT arthrography of the wrist. Semin Musculoskelet Radiol 2012; 16 (01) 27-41
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 26 Ringler MD, Murthy NS. MR imaging of wrist ligaments. Magn Reson Imaging Clin N Am 2015; 23 (03) 367-391
    CrossrefPubMedGoogle Scholar
  • 27 Moser T, Dosch JC, Moussaoui A, Buy X, Gangi A, Dietemann JL. Multidetector CT arthrography of the wrist joint: how to do it. Radiographics 2008; 28 (03) 787-800 ; quiz 911
    CrossrefPubMedGoogle Scholar
  • 28 Hafezi-Nejad N, Carrino JA, Eng J. et al. Scapholunate interosseous ligament tears: diagnostic performance of 1.5 T, 3 T MRI, and MR arthrography—a systematic review and meta-analysis. Acad Radiol 2016; 23 (09) 1091-1103
    CrossrefPubMedGoogle Scholar
  • 29 Schmid MR, Schertler T, Pfirrmann CW. et al. Interosseous ligament tears of the wrist: comparison of multi-detector row CT arthrography and MR imaging. Radiology 2005; 237 (03) 1008-1013
    CrossrefPubMedGoogle Scholar
  • 30 Moser T, Dosch JC, Moussaoui A, Dietemann JL. Wrist ligament tears: evaluation of MRI and combined MDCT and MR arthrography. AJR Am J Roentgenol 2007; 188 (05) 1278-1286
    CrossrefPubMedGoogle Scholar
  • 31 Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am 2006; 31 (01) 125-134
    CrossrefPubMedGoogle Scholar
  • 32 Messina JC, Van Overstraeten L, Luchetti R, Fairplay T, Mathoulin CL. The EWAS classification of scapholunate tears: an anatomical arthroscopic study. J Wrist Surg 2013; 2 (02) 105-109
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 33 Smith DK. Volar carpal ligaments of the wrist: normal appearance on multiplanar reconstructions of three-dimensional Fourier transform MR imaging. AJR Am J Roentgenol 1993; 161 (02) 353-357
    CrossrefPubMedGoogle Scholar
  • 34 Theumann NH, Pfirrmann CW, Antonio GE. et al. Extrinsic carpal ligaments: normal MR arthrographic appearance in cadavers. Radiology 2003; 226 (01) 171-179
    CrossrefPubMedGoogle Scholar
  • 35 Timins ME, Jahnke JP, Krah SF, Erickson SJ, Carrera GF. MR imaging of the major carpal stabilizing ligaments: normal anatomy and clinical examples. Radiographics 1995; 15 (03) 575-587
    CrossrefPubMedGoogle Scholar
  • 36 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (03) 357-365
    CrossrefPubMedGoogle Scholar
  • 37 Berger RA, Landsmeer JM. The palmar radiocarpal ligaments: a study of adult and fetal human wrist joints. J Hand Surg Am 1990; 15 (06) 847-854
    CrossrefPubMedGoogle Scholar
  • 38 Shahabpour M, De Maeseneer M, Pouders C. et al. MR imaging of normal extrinsic wrist ligaments using thin slices with clinical and surgical correlation. Eur J Radiol 2011; 77 (02) 196-201
    CrossrefPubMedGoogle Scholar
  • 39 Shahabpour M, Van Overstraeten L, Ceuterick P. et al. Pathology of extrinsic ligaments: a pictorial essay. Semin Musculoskelet Radiol 2012; 16 (02) 115-128
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 40 Berger RA, Kauer JM, Landsmeer JM. Radioscapholunate ligament: a gross anatomic and histologic study of fetal and adult wrists. J Hand Surg Am 1991; 16 (02) 350-355
    CrossrefPubMedGoogle Scholar
  • 41 Taneja AK, Bredella MA, Chang CY, Joseph Simeone F, Kattapuram SV, Torriani M. Extrinsic wrist ligaments: prevalence of injury by magnetic resonance imaging and association with intrinsic ligament tears. J Comput Assist Tomogr 2013; 37 (05) 783-789
    CrossrefPubMedGoogle Scholar
  • 42 Mak WH, Szabo RM, Myo GK. Assessment of volar radiocarpal ligaments: MR arthrographic and arthroscopic correlation. AJR Am J Roentgenol 2012; 198 (02) 423-427
    CrossrefPubMedGoogle Scholar
  • 43 Scheck RJ, Romagnolo A, Hierner R, Pfluger T, Wilhelm K, Hahn K. The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy. J Magn Reson Imaging 1999; 9 (03) 468-474
    CrossrefPubMedGoogle Scholar
  • 44 Spaans AJ, Minnen Pv, Prins HJ, Korteweg MA, Schuurman AH. The value of 3.0-tesla MRI in diagnosing scapholunate ligament injury. J Wrist Surg 2013; 2 (01) 69-72
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 45 Hajek PC, Sartoris DJ, Gylys-Morin V. et al. The effect of intra-articular gadolinium-DTPA on synovial membrane and cartilage. Invest Radiol 1990; 25 (02) 179-183
    CrossrefPubMedGoogle Scholar
  • 46 Mitsuyasu H, Patterson RM, Shah MA, Buford WL, Iwamoto Y, Viegas SF. The role of the dorsal intercarpal ligament in dynamic and static scapholunate instability. J Hand Surg Am 2004; 29 (02) 279-288
    CrossrefPubMedGoogle Scholar
  • 47 Elsaidi GA, Ruch DS, Kuzma GR, Smith BP. Dorsal wrist ligament insertions stabilize the scapholunate interval: cadaver study. Clin Orthop Relat Res 2004; (425) 152-157
    CrossrefPubMedGoogle Scholar
  • 48 Slutsky DJ. Incidence of dorsal radiocarpal ligament tears in the presence of other intercarpal derangements. Arthroscopy 2008; 24 (05) 526-533
    CrossrefPubMedGoogle Scholar
  • 49 Becce F, Theumann N, Bollmann C. et al. Dorsal fractures of the triquetrum: MRI findings with an emphasis on dorsal carpal ligament injuries. AJR Am J Roentgenol 2013; 200 (03) 608-617
    CrossrefPubMedGoogle Scholar
  • 50 Smith DK. Dorsal carpal ligaments of the wrist: normal appearance on multiplanar reconstructions of three-dimensional Fourier transform MR imaging. AJR Am J Roentgenol 1993; 161 (01) 119-125
    CrossrefPubMedGoogle Scholar
  • 51 Özkan S, Kheterpal A, Palmer WE, Chen NC. Dorsal extrinsic ligament injury and static scapholunate diastasis on magnetic resonance imaging scans. J Hand Surg Am 2019; 44 (08) 641-648
    CrossrefPubMedGoogle Scholar
  • 52 Swann RP, Noureldin M, Kakar S. Dorsal radiotriquetral ligament snapping wrist syndrome—a novel presentation and review of literature: case report. J Hand Surg Am 2016; 41 (03) 344-7.e2
    CrossrefPubMedGoogle Scholar
  • 53 Brown RR, Fliszar E, Cotten A, Trudell D, Resnick D. Extrinsic and intrinsic ligaments of the wrist: normal and pathologic anatomy at MR arthrography with three-compartment enhancement. Radiographics 1998; 18 (03) 667-674
    CrossrefPubMedGoogle Scholar
  • 54 Tommasini Carrara de Sambuy M, Burgess TM, Cambon-Binder A, Mathoulin CL. The anatomy of the dorsal capsulo-scapholunate septum: a cadaveric study. J Wrist Surg 2017; 6 (03) 244-247
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 55 Van Overstraeten L, Camus EJ. Arthroscopic classification of the lesions of the dorsal capsulo-scapholunate septum (DCSS) of the wrist. Tech Hand Up Extrem Surg 2016; 20 (03) 125-128
    CrossrefPubMedGoogle Scholar
  • 56 Mathoulin C, Gras M. Role of wrist arthroscopy in scapholunate dissociation. Orthop Traumatol Surg Res 2020; 106 (1S): S89-S99
    CrossrefPubMedGoogle Scholar
  • 57 Morimoto H, Viegas SF, Nakamura K. et al. The scaphotrapeziotrapezoidal joint. Part 1: an anatomic and radiographic study. J Hand Surg Am 2000; 25A: 899-910
    PubMedGoogle Scholar
  • 58 Moritomo H, Viegas SF, Elder K, Nakamura K, Dasilva MF, Patterson RM. The scaphotrapezio-trapezoidal joint. Part 2: A kinematic study. J Hand Surg Am 2000; 25 (05) 911-920
    CrossrefPubMedGoogle Scholar
  • 59 Lichtman DM, Wroten ES. Understanding midcarpal instability. J Hand Surg Am 2006; 31 (03) 491-498
    CrossrefPubMedGoogle Scholar
  • 60 Lichtman DM, Bruckner JD, Culp RW, Alexander CE. Palmar midcarpal instability: results of surgical reconstruction. J Hand Surg Am 1993; 18 (02) 307-315
    CrossrefPubMedGoogle Scholar
  • 61 Toms AP, Chojnowski A, Cahir JG. Midcarpal instability: a radiological perspective. Skeletal Radiol 2011; 40 (05) 533-541
    CrossrefPubMedGoogle Scholar
  • 62 Sennwald GR, Zdravkovic V, Oberlin C. The anatomy of the palmar scaphotriquetral ligament. J Bone Joint Surg Br 1994; 76 (01) 147-149
    CrossrefPubMedGoogle Scholar
  • 63 Chang W, Peduto AJ, Aguiar RO, Trudell DJ, Resnick DL. Arcuate ligament of the wrist: normal MR appearance and its relationship to palmar midcarpal instability: a cadaveric study. Skeletal Radiol 2007; 36 (07) 641-645
    CrossrefPubMedGoogle Scholar
  • 64 Yoshioka H, Tanaka T, Ueno T. et al. High-resolution MR imaging of the proximal zone of the lunotriquetral ligament with a microscopy coil. Skeletal Radiol 2006; 35 (05) 288-294
    CrossrefPubMedGoogle Scholar
  • 65 Ishii S, Palmer AK, Werner FW, Short WH, Fortino MD. An anatomic study of the ligamentous structure of the triangular fibrocartilage complex. J Hand Surg Am 1998; 23 (06) 977-985
    CrossrefPubMedGoogle Scholar
  • 66 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
    CrossrefPubMedGoogle Scholar
  • 67 Tay SC, Berger RA, Parker WL. Longitudinal split tears of the ulnotriquetral ligament. Hand Clin 2010; 26 (04) 495-501
    CrossrefPubMedGoogle Scholar
  • 68 Zhan H, Zhang H, Bai R. et al. High-resolution 3-T MRI of the triangular fibrocartilage complex in the wrist: injury pattern and MR features. Skeletal Radiol 2017; 46 (12) 1695-1706
    CrossrefPubMedGoogle Scholar
  • 69 Theumann N, Kamel EM, Bollmann C, Sturzenegger M, Becce F. Bucket-handle tear of the triangular fibrocartilage complex: case report of a complex peripheral injury with separation of the distal radioulnar ligaments from the articular disc. Skeletal Radiol 2011; 40 (12) 1617-1621
    CrossrefPubMedGoogle Scholar
  • 70 Yoshioka H, Burns JE. Magnetic resonance imaging of triangular fibrocartilage. J Magn Reson Imaging 2012; 35 (04) 764-778
    CrossrefPubMedGoogle Scholar
  • 71 Ringler MD, Howe BM, Amrami KK, Hagen CE, Berger RA. Utility of magnetic resonance imaging for detection of longitudinal split tear of the ulnotriquetral ligament. J Hand Surg Am 2013; 38 (09) 1723-1727
    CrossrefPubMedGoogle Scholar
  • 72 Anderson ML, Skinner JA, Felmlee JP, Berger RA, Amrami KK. Diagnostic comparison of 1.5 Tesla and 3.0 Tesla preoperative MRI of the wrist in patients with ulnar-sided wrist pain. J Hand Surg Am 2008; 33 (07) 1153-1159
    CrossrefPubMedGoogle Scholar
  • 73 Sandman E, Boily M, Martineau PA. “Hockey wrist”: dorsal ulnotriquetral ligament injury. Can J Surg 2018; 61 (06) 398-404
    CrossrefPubMedGoogle Scholar
  • 74 Smith DK, Snearly WN. Lunotriquetral interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists. Radiology 1994; 191 (01) 199-202
    CrossrefPubMedGoogle Scholar
  • 75 Lee RK, Griffith JF, Ng AW. et al. Intrinsic carpal ligaments on MR and multidetector CT arthrography: comparison of axial and axial oblique planes. Eur Radiol 2017; 27 (03) 1277-1285
    CrossrefPubMedGoogle Scholar
  • 76 Garcia-Elias M. What about injury of the lunotriquetral complex: treatment principles. Chir Main 2003; 22: 57-64
    CrossrefPubMedGoogle Scholar
  • 77 Wagner ER, Elhassan BT, Rizzo M. Diagnosis and treatment of chronic lunotriquetral ligament injuries. Hand Clin 2015; 31 (03) 477-486
    CrossrefPubMedGoogle Scholar