The Biomechanical Basics of Carpal Imaging

Abstract

This case-based review explores the biomechanical foundations of the wrist by integrating advanced imaging findings with core anatomical and functional principles. We analyze six representative scenarios: distal radioulnar joint instability, ulnocarpal impaction, unstable triangular fibrocartilage complex tear, scapholunate ligament injury, posttraumatic ulnar translocation of the carpus, and scaphotrapeziotrapezoid osteoarthritis.

The cases reviewed here illustrate how static and dynamic stabilizers preserve carpal congruence and load transmission. We highlight the roles of the triangular fibrocartilage complex, the distal interosseous membrane, and the intrinsic and extrinsic ligament systems, along with the kinematic interplay between carpal rows and sensorimotor control mechanisms. We emphasize the value of magnetic resonance imaging, magnetic resonance arthrography, and wrist arthroscopy as essential tools for detecting instability and planning treatment. By applying biomechanical principles to imaging interpretation, we can enhance lesion pattern recognition, support informed surgical decision making, and foster a more effective multidisciplinary approach to wrist pathology.

Keywords

wrist injuries - biomechanics - instability - triangular fibrocartilage complex - magnetic resonance imaging

Publikationsverlauf

Artikel online veröffentlicht:
03. Dezember 2025

• References

• 1 Kijima Y, Viegas SF. Wrist anatomy and biomechanics. J Hand Surg Am 2009; 34 (08) 1555-1563
• 2 Eschweiler J, Li J, Quack V. et al. Anatomy, biomechanics, and loads of the wrist joint. Life (Basel) 2022; 12 (02) 188
• 3 Hagert E, Hagert CG. Understanding stability of the distal radioulnar joint through an understanding of its anatomy. Hand Clin 2010; 26 (04) 459-466
• 4 Schmitt R, Hesse N, Goehtz F, Prommersberger KJ, de Jonge M, Grunz JP. Carpal instability: I. Pathoanatomy. Semin Musculoskelet Radiol 2021; 25 (02) 191-202
• 5 Garcia-Elias M, Ananos D, Esplugas M, Hagert E, Heras-Palou C, Kakar S. Ligaments and muscles stabilizing the radio-ulno-carpal joint. J Hand Surg Eur Vol 2022; 47 (01) 65-72
• 6 Kleinman WB. Stability of the distal radioulnar joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function: what we have learned in 25 years. J Hand Surg Am 2007; 32 (07) 1086-1106
• 7 Flores DV, Umpire DF, Rakhra KS, Jibri Z, Belmar GAS. Distal radioulnar joint: normal anatomy, imaging of common disorders, and injury classification. Radiographics 2023; 43 (01) e220109
• 8 Moritomo H. The distal interosseous membrane: current concepts in wrist anatomy and biomechanics. J Hand Surg Am 2012; 37 (07) 1501-1507
• 9 Haugstvedt JR, Langer MF, Berger RA. Distal radioulnar joint: functional anatomy, including pathomechanics. J Hand Surg Eur Vol 2017; 42 (04) 338-345
• 10 Poppler LH, Moran SL. Acute distal radioulnar joint instability: evaluation and treatment. Hand Clin 2020; 36 (04) 429-441
• 11 Zampetakis K, Stavrakakis IM, Alpantaki K. et al. Systematic review of acute isolated distal radioulnar joint dislocation: treatment options. J Clin Med 2024; 13 (24) 7817
• 12 Carlsen BT, Dennison DG, Moran SL. Acute dislocations of the distal radioulnar joint and distal ulna fractures. Hand Clin 2010; 26 (04) 503-516
• 13 Gulati A, Wadhwa V, Ashikyan O, Cerezal L, Chhabra A. Current perspectives in conventional and advanced imaging of the distal radioulnar joint dysfunction: review for the musculoskeletal radiologist. Skeletal Radiol 2019; 48 (03) 331-348
• 14 Arimitsu S, Moritomo H, Kitamura T. et al. The stabilizing effect of the distal interosseous membrane on the distal radioulnar joint in an ulnar shortening procedure: a biomechanical study. J Bone Joint Surg Am 2011; 93 (21) 2022-2030
• 15 Noda K, Goto A, Murase T, Sugamoto K, Yoshikawa H, Moritomo H. Interosseous membrane of the forearm: an anatomical study of ligament attachment locations. J Hand Surg Am 2009; 34 (03) 415-422
• 16 Orbay JL, Gardner B, Heifner JJ, Martin A, Mercer DM. The contribution of the distal oblique band to distal radioulnar joint stability. J Hand Surg Am 2025; 50 (06) 753.e1-753.e5
• 17 Gofton WT, Gordon KD, Dunning CE, Johnson JA, King GJW. Soft-tissue stabilizers of the distal radioulnar joint: an in vitro kinematic study. J Hand Surg Am 2004; 29 (03) 423-431
• 18 Omokawa S, Gumpangseth T, Komutrattananont P, Inchai C, Mahakkanukrauh P. Anatomical study of stabilizing structures of the extensor carpi ulnaris tendon around the wrist. J Hand Surg Am 2021; 46 (10) 930.e1-930.e9
• 19 Cerezal L, del Piñal F, Abascal F, García-Valtuille R, Pereda T, Canga A. Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics 2002; 22 (01) 105-121
• 20 Cerezal L, del Piñal F, Abascal F. MR imaging findings in ulnar-sided wrist impaction syndromes. Magn Reson Imaging Clin N Am 2004; 12 (02) 281-299 , vi
• 21 Cerezal L, Del Piñal F, Atzei A. et al. Interdisciplinary consensus statements on imaging of DRUJ instability and TFCC injuries. Eur Radiol 2023; 33 (09) 6322-6338
• 22 Serfaty A, Costa HP, Foelker CE, Filho ENK, Souza FF, Bordalo-Rodrigues M. Evaluation of ulnar variance on wrist MR imaging: is it a reliable measure?. Skeletal Radiol 2020; 49 (05) 723-730
• 23 Tomaino MM. The importance of the pronated grip X-ray view in evaluating ulnar variance. J Hand Surg Am 2000; 25 (02) 352-357
• 24 Harley BJ, Pereria ML, Werner FW, Kinney DA, Sutton LG. Force variations in the distal radius and ulna: effect of ulnar variance and forearm motion. J Hand Surg Am 2015; 40 (02) 211-216
• 25 Llopis E, Restrepo R, Kassarjian A, Cerezal L. Overuse injuries of the wrist. Radiol Clin North Am 2019; 57 (05) 957-976
• 26 Camus EJ, Van Overstraeten L. Kienböck's disease in 2021. Orthop Traumatol Surg Res 2022; 108 (1S): 103161
• 27 Serrano-Belmar GA. Ulnar peripheral tears of the triangular fibrocartilage complex: multiplanar approach of injury patterns with a focus on CT arthrography. J Mex Fed Radiol Imaging 2024; 3 (01) 4-16
• 28 Nakamura T, Takayama S, Horiuchi Y, Yabe Y. Origins and insertions of the triangular fibrocartilage complex: a histological study. J Hand Surg [Br] 2001; 26 (05) 446-454
• 29 Atzei A, Luchetti R, Garagnani L. Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears. J Hand Surg Eur Vol 2017; 42 (04) 405-414
• 30 del Piñal F. The 1B constellation: an attempt to classify Palmer 1B class. In: del Piñal F, Mathoulin C, Nakamura T. eds. Arthroscopic Management of Ulnar Pain. Heidelberg, Germany: Springer; 2012: 87-97
• 31 Shahabpour M, Abid W, Van Overstraeten L, Van Royen K, De Maeseneer M. Extrinsic and intrinsic ligaments of the wrist. Semin Musculoskelet Radiol 2021; 25 (02) 311-328
• 32 Wessel LE, Wolfe SW. Scapholunate instability: diagnosis and management - anatomy, kinematics, and clinical assessment - Part I. J Hand Surg Am 2023; 48 (11) 1139-1149
• 33 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
• 34 Wessel LE, Kim J, Morse KW. et al. The dorsal ligament complex: a cadaveric, histology, and imaging study. J Hand Surg Am 2022; 47 (05) 480.e1-480.e9
• 35 Schmitt R, Froehner S, Coblenz G, Christopoulos G. Carpal instability. Eur Radiol 2006; 16 (10) 2161-2178
• 36 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
• 37 Pérez AJ, Jethanandani RG, Vutescu ES, Meyers KN, Lee SK, Wolfe SW. Role of ligament stabilizers of the proximal carpal row in preventing dorsal intercalated segment instability: a cadaveric study. J Bone Joint Surg Am 2019; 101 (15) 1388-1396
• 38 Moritomo H, Murase T, Goto A, Oka K, Sugamoto K, Yoshikawa H. In vivo three-dimensional kinematics of the midcarpal joint of the wrist. J Bone Joint Surg Am 2006; 88 (03) 611-621
• 39 Mathoulin C, Merlini L, Taleb C. Scapholunate injuries: challenging existing dogmas in anatomy and surgical techniques. J Hand Surg Eur Vol 2021; 46 (01) 5-13
• 40 Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2012; 37 (10) 2175-2196
• 41 Corella F, Del Cerro M, Ocampos M, Simon de Blas C, Larrainzar-Garijo R. Arthroscopic scapholunate ligament reconstruction, volar and dorsal reconstruction. Hand Clin 2017; 33 (04) 687-707
• 42 Salva-Coll G, Lluch A, Esplugas M. et al. Scapholunate and lunotriquetral joint dynamic stabilizers and their role in wrist neuromuscular control and proprioception. J Hand Ther 2024; 37 (02) 273-281
• 43 Fok MWM, Fernandez DL, Maniglio M. Carpal instability nondissociative following acute wrist fractures. J Hand Surg Am 2020; 45 (07) 662.e1-662.e10
• 44 Zelenski NA, Shin AY. Management of nondissociative instability of the wrist. J Hand Surg Am 2020; 45 (02) 131-139
• 45 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
• 46 Berschback JC, Kalainov DM, Husain SN, Wiedrich TA, Cohen MS, Nagle DJ. Traumatic ulnar translocation of the carpus: early recognition and treatment. J Hand Surg Eur Vol 2012; 37 (08) 755-764
• 47 Rayhack JM, Linscheid RL, Dobyns JH, Smith JH. Posttraumatic ulnar translation of the carpus. J Hand Surg Am 1987; 12 (02) 180-189
• 48 Innocenti M, Fok MWM, Piacentini F. Ligaments reconstruction for posttraumatic ulnar translocation of the carpus: a case report. J Wrist Surg 2017; 6 (04) 325-328
• 49 Visser T, Borusiewicz M, Payatakes A. Traumatic ulnar carpal translocation, distal radioulnar joint subluxation with occult perilunate injury. J Wrist Surg 2024; 14 (02) 165-169
• 50 Loisel F, Orr S, Ross M, Couzens G, Leo AJ, Wolfe S. Traumatic nondissociative carpal instability: a case series. J Hand Surg Am 2022; 47 (03) 285.e1-285.e11
• 51 Corella F, Ocampos M, Laredo R, Tabuenca J, Larrainzar-Garijo R. Arthroscopic volar capsuloligamentous reattachment and reinforcement to bone. J Wrist Surg 2023; 13 (02) 98-119
• 52 Tay SC, Moran SL, Shin AY, Linscheid RL. The clinical implications of scaphotrapezium-trapezoidal arthritis with associated carpal instability. J Hand Surg Am 2007; 32 (01) 47-54
• 53 Moritomo H, Viegas SF, Nakamura K, Dasilva MF, Patterson RM. The scaphotrapezio-trapezoidal joint. Part 1: An anatomic and radiographic study. J Hand Surg Am 2000; 25 (05) 899-910
• 54 Pinto CH, Obermann WR, Deijkers RL. Nontraumatic multidirectional instability of the scaphotrapeziotrapezoid joint: a cause of scaphotrapeziotrapezoid osteoarthritis and static distal intercalated segment instability. J Hand Surg Am 2003; 28 (05) 744-750
• 55 Alder KD, Feroe AG, Karim KE. Management of scaphotrapeziotrapezoid osteoarthritis: a critical analysis review. JBJS Rev 2023; 11 (10) 00093
• 56 Catalano III LW, Ryan DJ, Barron OA, Glickel SZ. Surgical management of scaphotrapeziotrapezoid arthritis. J Am Acad Orthop Surg 2020; 28 (06) 221-228
• 57 Oliveira R, Aita M, Brunelli J, Carratalá V, Delgado P. Introducing the “SOAC wrist”: scaphotrapeziotrapezoid osteoarthritis advanced collapse. Rev Iberoam Cirugía Mano 2020; 48 (02) 93-100
• 58 Jin DU, Hwang JS, Gong HS. The impact of lunate type on scapho-trapezio-trapezoid arthritis in trapeziometacarpal osteoarthritis patients. J Plast Reconstr Aesthet Surg 2025; 102: 1-8