Extrinsic and Intrinsic Ligaments of the Wrist: Normal and Pathologic Anatomy at MR Arthrography with Three-Compartment Enhancement

Department of Radiology, Veterans Affairs Medical Center, San Diego, CA 92161, USA.
Radiographics (Impact Factor: 2.6). 05/1998; 18(3):667-74. DOI: 10.1148/radiographics.18.3.9599390
Source: PubMed


The ligaments of the wrist have been demonstrated with magnetic resonance (MR) imaging by many authors. Distinction has been made between the extrinsic, or radiocarpal and ulnocarpal, ligaments and the intrinsic, or intercarpal, ligaments. The stability of the wrist depends on numerous ligaments: The volar ligaments are important stabilizers of the wrist, whereas the dorsal ligaments are less crucial for wrist stability. An MR imaging protocol that demonstrates these structures with high resolution has been developed. Cadaveric wrists are imaged with a spoiled gradient-recalled-echo volume-acquisition technique with fat suppression after three-compartment enhancement with a contrast agent containing gadolinium. The specimens are then sectioned, and the anatomic and pathologic findings are correlated with the findings on the MR images. The extrinsic and intrinsic ligaments of the wrist are clearly demonstrated with this technique. This protocol was designed for anatomic study and promotes understanding of the anatomy and biomechanics of the wrist; it is not intended for clinical use.

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    • "The ulnar collateral (UC) ligament has never been visualized sonographically [16]. It is part of the triangular fibrocartilage complex and is more appropriately regarded not as a ligament but as a thickening of the joint capsule extending from the ulnar styloid process to the triquetrum and the pisiform [16]. "
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    ABSTRACT: Thanks to its intrinsic high spatial resolution, ultrasound is an ideal imaging modality for examining very thin, superficial structures, and this makes it very helpful in the evaluation of extrinsic carpal ligaments. These structures, which arise from the radius and ulna and insert on the carpal bones, are extremely important for wrist stability. Previous studies have assessed the use of ultrasound to study the extrinsic carpal ligaments in cadavers, healthy asymptomatic subjects, and patients with rheumatoid arthritis. In the present report, we review the normal anatomy, biomechanics, and ultrasound appearance of these ligaments.
    Journal of Ultrasound 12/2012; 15(4):267-72. DOI:10.1016/j.jus.2012.09.004
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    • "Their obliquely oriented fibers attach to the capitate, forming a supporting structure that links the proximal and distal carpal rows [1]. The TH ligament extends from the distal margin of the palmar cortex of the triquetrum, ulnar to the triquetrocapitate ligament, to the palmar cortex of the hamate [1, 2]. The STT ligament connects the scaphoid to the trapezium and trapezoid, its fibers attaching to the radial and ulnar cortices of the distal pole of the scaphoid, forming a V-shaped structure. "
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    ABSTRACT: To demonstrate how radial and ulnar deviation of the wrist can affect the visualization of the intrinsic intercarpal ligaments using magnetic resonance (MR) imaging, MR arthrography and gross anatomic inspection in cadavers. The detectability of the intrinsic intercarpal ligaments of ten fresh human wrists was analyzed in coronal, axial and sagittal images in the neutral position and in radial and ulnar deviation with MR imaging and MR arthrography. The findings were then correlated with gross anatomic inspection. Additionally, quantitative measurements including the radiocarpal distances and capitate angles were performed. Differences were noted in the visual conspicuity of only the intercarpal ligaments of the proximal carpal row with different techniques and wrist positions. The average width of the radiocarpal joint was 0.62 mm, 1.55 mm and 2.0 mm (radial side) and 3.78 mm, 2.25 mm and 1.16 mm (ulnar side) in radial deviation, neutral position, and ulnar deviation of the wrist, respectively. Statistically, these maneuvers produced significant opening in the ulnar side during radial deviation (Student's t-test; P = 0.0005) and in the radial side in ulnar deviation (P = 0.007). Significant differences in the width of the radiocarpal joint were observed during radial and ulnar deviation of the wrist, influencing the visualization of the intrinsic ligaments, mainly the scapholunate and lunotriquetral ligaments. The use of MR arthrography with radial and/or ulnar deviation has the potential to improve diagnosis in clinical cases in which injury to one or both of these ligaments is suggested.
    Skeletal Radiology 10/2009; 39(8):799-805. DOI:10.1007/s00256-009-0796-5 · 1.51 Impact Factor
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    • "MR imaging can visualize tears of these ligaments , which appear with increased signal intensity, irregularity, and fraying, and correspond to high signal intensity on T2 sequences. MR arthrography could potentially evaluate dorsal and volar extrinsic ligaments tears because of its high resolution and excellent contrast between ligaments and surrounding structures; however, its exact use in the evaluation of these lesions is yet to be clearly defined [2] [17] [20] [22]. "
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    ABSTRACT: MR imaging of the wrist frequently represents a diagnostic challenge for radiologists because of the complex anatomy of this joint, small size of its components, and little known pathologic conditions. MR arthrography combines the advantages of conventional MR imaging and arthrography by improving the visualization of small intra-articular abnormalities. This article reviews the current role of MR arthrography in the evaluation of wrist joint disorders considering the relevant aspects of anatomy, techniques, and applications.
    Radiologic Clinics of North America 08/2005; 43(4):709-31, viii. DOI:10.1016/j.rcl.2005.02.004 · 1.98 Impact Factor
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