RSS-Feed abonnieren
DOI: 10.1055/s-0041-1724224
Narrative Review of Ligamentous Wrist Injuries
Funding None.![](https://www.thieme-connect.de/media/10.1055-s-00031417/202102/lookinside/thumbnails/10.1055-s-0041-1724224-1.jpg)
Abstract
Ligamentous wrist injuries are common occurrences that require complex anatomical mastery and extensive understanding of diagnostic and treatment modalities. The purpose of this educational review article is to delve into the most clinically relevant wrist ligaments in an organized manner to provide the reader with an overview of relevant anatomy, function, clinical examination findings, imaging modalities, and options for management. Emphasis is placed on elucidating reported diagnostic accuracies and treatment outcomes to encourage evidence-based practice.
Publikationsverlauf
Artikel online veröffentlicht:
28. Februar 2021
© 2021. Society of Indian Hand & Microsurgeons. All rights reserved. Thieme Medical and Scientific Publishers Pvt. Ltd., A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Chim H, Moran SL. Wrist essentials: the diagnosis and management of scapholunate ligament injuries. Plast Reconstr Surg 2014; 134 (02) 312e-322e
- 2 Sammer DM, Shin AY. Wrist surgery: management of chronic scapholunate and lunotriquetral ligament injuries. Plast Reconstr Surg 2012; 130 (01) 138e-156e
- 3 Ozçelik A, Günal I, Köse N, Seber S, Omeroğlu H. Wrist ligaments: their significance in carpal instability. Ulus Travma Acil Cerrahi Derg 2005; 11 (02) 115-120
- 4 Connell D, Page P, Wright W, Hoy G. Magnetic resonance imaging of the wrist ligaments. Australas Radiol 2001; 45 (04) 411-422
- 5 Smith DK. Volar carpal ligaments of the wrist: normal appearance on multiplanar reconstructions of three-dimensional Fourier transform MR imaging. Am J Roentgenol 1993; 161 (02) 353-357
- 6 Bencardino JT, Rosenberg ZS. Sports-related injuries of the wrist: an approach to MRI interpretation. Clin Sports Med 2006; 25 (03) 409-432
- 7 van Kooten EO, Coster E, Segers MJ, Ritt MJ. Early proximal row carpectomy after severe carpal trauma. Injury 2005; 36 (10) 1226-1232
- 8 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
- 9 Yuan BJ, Dennison DG, Elhassan BT, Kakar S. Outcomes after radiocarpal dislocation: a retrospective review. Hand (N Y) 2015; 10 (03) 367-373
- 10 Rominger MB, Bernreuter WK, Kenney PJ, Lee DH. MR imaging of anatomy and tears of wrist ligaments. Radiographics 1993; 13 (06) 1233-1246
- 11 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
- 12 Adler BD, Logan PM, Janzen DL. et al. Extrinsic radiocarpal ligaments: magnetic resonance imaging of normal wrists and scapholunate dissociation. Can Assoc Radiol J 1996; 47 (06) 417-422
- 13 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
- 14 Mak WH, Szabo RM, Myo GK. Assessment of volar radiocarpal ligaments: MR arthrographic and arthroscopic correlation. Am J Roentgenol 2012; 198 (02) 423-427
- 15 Lacelli F, Muda A, Sconfienza LM, Schettini D, Garlaschi G, Silvestri E. High-resolution ultrasound anatomy of extrinsic carpal ligaments. Radiol Med (Torino) 2008; 113 (04) 504-516
- 16 Boutry N, Lapegue F, Masi L, Claret A, Demondion X, Cotten A. Ultrasonographic evaluation of normal extrinsic and intrinsic carpal ligaments: preliminary experience. Skeletal Radiol 2005; 34 (09) 513-521
- 17 Dunn MJ, Johnson C. Static scapholunate dissociation: a new reconstruction technique using a volar and dorsal approach in a cadaver model. J Hand Surg Am 2001; 26 (04) 749-754
- 18 Moritomo H. Anatomy and clinical relevance of the ulnocarpal ligament. J Wrist Surg 2013; 2 (02) 186-189
- 19 Berger RA. The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions. Hand Clin 1997; 13 (01) 63-82
- 20 Taljanovic MS, Goldberg MR, Sheppard JE, Rogers LF. US of the intrinsic and extrinsic wrist ligaments and triangular fibrocartilage complex–normal anatomy and imaging technique. Radiographics 2011; 31 (01) e44
- 21 Berger RA. The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop Relat Res 2001; (383) 32-40
- 22 Bateni CP, Bartolotta RJ, Richardson ML, Mulcahy H, Allan CH. Imaging key wrist ligaments: what the surgeon needs the radiologist to know. Am J Roentgenol 2013; 200 (05) 1089-1095
- 23 Allieu Y, Garcia-Elias M. Dynamic radial translation instability of the carpus. J Hand Surg [Br] 2000; 25 (01) 33-37
- 24 Moritomo H, Murase T, Arimitsu S, Oka K, Yoshikawa H, Sugamoto K. Change in the length of the ulnocarpal ligaments during radiocarpal motion: possible impact on triangular fibrocartilage complex foveal tears. J Hand Surg Am 2008; 33 (08) 1278-1286
- 25 Mooney JF, Poehling GG. Disruption of the ulnolunate ligament as a cause of chronic ulnar wrist pain. J Hand Surg Am 1991; 16 (02) 347-349
- 26 Sato R, Hibino N, Hamada Y, Sairyo K. Ulnolunate Ligament Avulsion Fracture of the Lunate: A Case Report. J Wrist Surg 2017; 6 (02) 148-151
- 27 Tay SC, Berger RA, Parker WL. Longitudinal split tears of the ulnotriquetral ligament. Hand Clin 2010; 26 (04) 495-501
- 28 Hyatt BT, Rhee PC. Longitudinal split tears of the ulnotriquetral ligament. Oper Tech Sports Med 2016; 24 (02) 126-130
- 29 Tay SC, Tomita K, Berger RA. The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am 2007; 32 (04) 438-444
- 30 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
- 31 Tang CQY, Lai SWH, Leow G, Tay SC. Patient-reported outcome following ulnotriquetral ligament split tear repair. J Hand Surg Asian Pac Vol 2017; 22 (04) 445-451
- 32 Viegas SF, Yamaguchi S, Boyd NL, Patterson RM. The dorsal ligaments of the wrist: anatomy, mechanical properties, and function. J Hand Surg Am 1999; 24 (03) 456-468
- 33 Slutsky DJ. Incidence of dorsal radiocarpal ligament tears in the presence of other intercarpal derangements. Arthroscopy 2008; 24 (05) 526-533
- 34 Slutsky DJ. The management of dorsal radiocarpal ligament tears. J Hand Surg Am 2005; 5 (03) 167-174
- 35 Slutsky DJ. The incidence of dorsal radiocarpal ligament tears in patients having diagnostic wrist arthroscopy for wrist pain. J Hand Surg Am 2008; 33 (03) 332-334
- 36 Slutsky DJ. Arthroscopic repair of dorsal radiocarpal ligament tears. Arthroscopy 2002; 18 (09) E49
- 37 Slutsky DJ. Arthroscopic dorsal radiocarpal ligament repair. Arthroscopy 2005; 21 (12) 1486
- 38 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist–anatomy and function. J Hand Surg Am 1981; 6 (02) 153-162
- 39 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
- 40 Chan JJ, Teunis T, Ring D. Prevalence of triangular fibrocartilage complex abnormalities regardless of symptoms rise with age: systematic review and pooled analysis. Clin Orthop Relat Res 2014; 472 (12) 3987-3994
- 41 Unglaub F, Wolf MB, Thome MA, Germann G, Sauerbier M, Reiter A. Correlation of ulnar length and apoptotic cell death in degenerative lesions of the triangular fibrocartilage. Arthroscopy 2008; 24 (03) 299-304
- 42 Henry MH. Management of acute triangular fibrocartilage complex injury of the wrist. J Am Acad Orthop Surg 2008; 16 (06) 320-329
- 43 Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg [Br] 1997; 22 (06) 719-723
- 44 Ahn AK, Chang D, Plate AM. Triangular fibrocartilage complex tears: a review. Bull NYU Hosp Jt Dis 2006; 64 (3-4) 114-118
- 45 Blazar PE, Chan PS, Kneeland JB, Leatherwood D, Bozentka DJ, Kowalchick R. The effect of observer experience on magnetic resonance imaging interpretation and localization of triangular fibrocartilage complex lesions. J Hand Surg Am 2001; 26 (04) 742-748
- 46 Haims AH, Schweitzer ME, Morrison WB. et al. Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist. AJR Am J Roentgenol 2002; 178 (02) 419-422
- 47 Potter HG, Asnis-Ernberg L, Weiland AJ. Hotchkiss RN, Peterson MG, McCormack RR Jr. The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. J Bone Joint Surg Am 1997; 79 (11) 1675-1684
- 48 Joshy S, Ghosh S, Lee K, Deshmukh SC. Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist. Int Orthop 2008; 32 (02) 251-253
- 49 Lee RK, Ng AW, Tong CS. et al. Intrinsic ligament and triangular fibrocartilage complex tears of the wrist: comparison of MDCT arthrography, conventional 3-T MRI, and MR arthrography. Skeletal Radiol 2013; 42 (09) 1277-1285
- 50 Pederzini L, Luchetti R, Soragni O. et al. Evaluation of the triangular fibrocartilage complex tears by arthroscopy, arthrography, and magnetic resonance imaging. Arthroscopy 1992; 8 (02) 191-197
- 51 Boer BC, Vestering M, van Raak SM, van Kooten EO, Huis In ’t Veld R, Vochteloo AJH. MR arthrography is slightly more accurate than conventional MRI in detecting TFCC lesions of the wrist. Eur J Orthop Surg Traumatol 2018; 28 (08) 1549-1553
- 52 Lee RK, Griffith JF, Ng AW, Nung RC, Yeung DK. Wrist traction during MR arthrography improves detection of triangular fibrocartilage complex and intrinsic ligament tears and visibility of articular cartilage. AJR Am J Roentgenol 2016; 206 (01) 155-161
- 53 Treiser MD, Crawford K, Iorio ML. TFCC injuries: meta-analysis and comparison of diagnostic imaging modalities. J Wrist Surg 2018; 7 (03) 267-272
- 54 Trehan SK, Wall LB, Calfee RP. et al. Arthroscopic diagnosis of the triangular fibrocartilage complex foveal tear: a cadaver assessment. J Hand Surg Am 2018; 43 (07) 680.e1-680.e5
- 55 Park A, Lutsky K, Matzon J, Leinberry C, Chapman T, Beredjiklian PK. An evaluation of the reliability of wrist arthroscopy in the assessment of tears of the triangular fibrocartilage complex. J Hand Surg Am 2018; 43 (06) 545-549
- 56 Bernstein MA, Nagle DJ, Martinez A. Stogin JM Jr, Wiedrich TA. A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. Arthroscopy 2004; 20 (04) 392-401
- 57 Minami A, Ishikawa J, Suenaga N, Kasashima T. Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement. J Hand Surg Am 1996; 21 (03) 406-411
- 58 Kovachevich R, Elhassan BT. Arthroscopic and open repair of the TFCC. Hand Clin 2010; 26 (04) 485-494
- 59 Andersson JK, Åhlén M, Andernord D. Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review. J Exp Orthop 2018; 5 (01) 6
- 60 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
- 61 Binder AC, Kerfant N, Wahegaonkar AL, Tandara AA, Mathoulin CL. Dorsal wrist capsular tears in association with scapholunate instability: results of an arthroscopic dorsal capsuloplasty. J Wrist Surg 2013; 2 (02) 160-167
- 62 Athlani L, Pauchard N, Dautel G. Outcomes of scapholunate intercarpal ligamentoplasty for chronic scapholunate dissociation: a prospective study in 26 patients. J Hand Surg Eur Vol 2018; 43 (07) 700-707
- 63 Berger RA, Imeada T, Berglund L, An KN. Constraint and material properties of the subregions of the scapholunate interosseous ligament. J Hand Surg Am 1999; 24 (05) 953-962
- 64 Berger RA. The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 1996; 21 (02) 170-178
- 65 Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am 1980; 5 (03) 226-241
- 66 Lans J, Lasa A, Chen NC, Jupiter JB. Incidence and functional outcomes of scapholunate diastases associated distal radius fractures: a 2-year follow-up scapholunate dissociation. Open Orthop J 2018; 12: 33-40
- 67 Lee DJ, Elfar JC. Carpal ligament injuries, pathomechanics, and classification. Hand Clin 2015; 31 (03) 389-398
- 68 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
- 69 Watson HK, Ashmead IV D, Makhlouf MV. Examination of the scaphoid. J Hand Surg Am 1988; 13 (05) 657-660
- 70 LaStayo P, Howell J. Clinical provocative tests used in evaluating wrist pain: a descriptive study. J Hand Ther 1995; 8 (01) 10-17
- 71 Lee SK, Desai H, Silver B, Dhaliwal G, Paksima N. Comparison of radiographic stress views for scapholunate dynamic instability in a cadaver model. J Hand Surg Am 2011; 36 (07) 1149-1157
- 72 Andersson JK, Andernord D, Karlsson J, Fridén J. Efficacy of magnetic resonance imaging and clinical tests in diagnostics of wrist ligament injuries: a systematic review. Arthroscopy 2015; 31 (10) 2014-20.e2
- 73 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
- 74 Greditzer HGT IV, Zeidenberg J, Kam CC. et al. Optimal detection of scapholunate ligament tears with MRI. Acta Radiol 2016; 57 (12) 1508-1514
- 75 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
- 76 Kakar S, Breighner RE, Leng S. et al. The role of dynamic (4D) CT in the detection of scapholunate ligament injury. J Wrist Surg 2016; 5 (04) 306-310
- 77 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
- 78 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
- 79 Saltzman BM, Frank JM, Slikker W, Fernandez JJ, Cohen MS, Wysocki RW. Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review. J Hand Surg Eur Vol 2015; 40 (05) 450-457
- 80 Ritt MJ, Bishop AT, Berger RA, Linscheid RL, Berglund LJ, An KN. Lunotriquetral ligament properties: a comparison of three anatomic subregions. J Hand Surg Am 1998; 23 (03) 425-431
- 81 Shin AY, Battaglia MJ, Bishop AT. Lunotriquetral instability: diagnosis and treatment. J Am Acad Orthop Surg 2000; 8 (03) 170-179
- 82 Reagan DS, Linscheid RL, Dobyns JH. Lunotriquetral sprains. J Hand Surg Am 1984; 9 (04) 502-514
- 83 Van L Overstraeten, 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
- 84 Horii E, Garcia-Elias M, An KN. et al. A kinematic study of luno-triquetral dissociations. J Hand Surg Am 1991; 16 (02) 355-362
- 85 Trumble TE, Bour CJ, Smith RJ, Glisson RR. Kinematics of the ulnar carpus related to the volar intercalated segment instability pattern. J Hand Surg Am 1990; 15 (03) 384-392
- 86 Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am 2012; 37 (07) 1489-1500
- 87 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
- 88 Nicoson MC, Moran SL. Diagnosis and treatment of acute lunotriquetral ligament injuries. Hand Clin 2015; 31 (03) 467-476
- 89 Shin AY, Weinstein LP, Berger RA, Bishop AT. Treatment of isolated injuries of the lunotriquetral ligament. A comparison of arthrodesis, ligament reconstruction and ligament repair. J Bone Joint Surg Br 2001; 83 (07) 1023-1028