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Schematic diagram of dorsal extrinsic wrist ligaments. IC dorsal intercarpal ligament, RSL dorsal radioscaphoid ligament, RLT dorsal radiolunotriquetral ligament, Tm trapezium, Tz trapezoid, S scaphoid, C capitate, L lunate, H hamate, T triquetrium

Schematic diagram of dorsal extrinsic wrist ligaments. IC dorsal intercarpal ligament, RSL dorsal radioscaphoid ligament, RLT dorsal radiolunotriquetral ligament, Tm trapezium, Tz trapezoid, S scaphoid, C capitate, L lunate, H hamate, T triquetrium

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Radial wrist pain is a common clinical complaint. The relatively complex anatomy in this region, combined with the small size of the anatomical structures and occasionally subtle imaging findings, can pose problems when trying to localize the exact cause of pain. To fully comprehend the underlying pathology, one needs a good understanding of both r...

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... The most of variations can be identified via X-ray and their respective sequences of the conventional computed tomography (CT). [1] Since an axial CT scan accurately delineates the cross-sectional anatomy of the distal radius and carpal region, it is also useful for identifying principal reference axes, which are critical in analyzing rotational anatomy. The axial plane of the CT scan is also essential to investigate the associations between certain clinical conditions and rotational/torsional malalignments in the other skeletal regions. ...
... distal radioulnar joint (DRUJ) instability, and scapholunate ligament injury. [1,[4][5][6][7] However, available data are problematic due to the different landmarks and principal axes preferred for reference. Several different anatomical locations have been used as a principal axis of the distal radius in the past; the central (mediolateral radiocarpal joint) axis, volar cortical axis (at distal metaphyseal level), and sigmoid notch axis. ...
... The principal axes of the wrist on axial CT sections are used as a reference in studies for following conditions: the distal radius anatomy, [1,4,8,15] rotational malalignment due to distal radius or shaft fractures, [7,9,16] anatomic and kinematic studies of the carpal region, [5,6,10] and DRUJ anatomy. [5,11,12,[17][18][19] Several anatomical locations have been used as principal axis of the distal radius in the past, including, the central axis, [4,[7][8][9]11,12,16] volar cortical axis at metaphyseal level, [5,8,9] and sigmoid notch axis. ...
Article
Objectives: This study aims to identify the most accurate dorsovolar principal axis of the distal radius and carpus identified on axial computed tomography (CT) sections and to establish normative data for angular measurements among these axes. Patients and methods: Between December 2019 and December 2021, normal axial CT images of wrists of a total of 42 individuals (25 males, 17 females; mean age: 31±8.4 years; range, 18 to 45 years) were retrospectively analyzed. Eight axes were identified on axial CT images: four distal radial axes (the volar cortical, medial cortical, central, and sigmoid notch axes) and four carpal axes (the scapholunate, lunotriquetral, capitohamate, and pisotrapezial axes). Twenty-two angular parameters were measured with reference to four principal axes (the volar cortical, medial cortical, central, and pisotrapezial axes). Results: The mean sigmoid notch rotation (version) angles relative to the four principal axes were 8±5° (range, -2° to 18°), 6±5° (range, -2° to 13°), 1±5° (range, -8° to 14°), and 4±4° (range, -3° to 15°), respectively. The mean scapholunate rotation angles were -13±5° (range, -27° to -6°), -15±6° (range, -29° to -8°), -21±5° (range, -30° to -11°), and -8±5° (range, -28° to -6°), respectively. Among four principal axes, the volar cortical and medial cortical axes were nearly collinear with both of relatively fixed carpal axes. The four principal axes showed angular differences between 2° and 8° with each other. There was no significant difference between men and women for all measurements. Conclusion: The axial CT sections can be used to describe the various angulations between the normal wrist axes such as the sigmoid notch and scapholunate joint rotation angles. Despite slight differences among the four principal axes, the volar cortical and medial cortical axes are more consistent with the relatively fixed carpal axes.
... Ultrasound was made possible by its imaging, practicality, capabilities and dynamic component. Therefore, it is increasingly used as a first-line investigation for wrist soft-tissue abnormalities (2) . The distal radioulnar joint (DRUJ) is stabilized by the triangular fibrocartilage complex (TFCC), which acts as a cushion for the ulnar head and lunate during wrist axial stress and ulnar deviation, and also restricts carpus ulnar deviation (3) . ...
... Conventional positioning methodology for plain radiography of a lateral wrist projection often describes the rotation of the wrist 90° from the PA by raising the radial aspect. 1,2,4,5,[11][12][13][14][15][19][20][21] This provides an image with appropriate superimposition of the radius and ulna; however, it does not account for the anatomy and biomechanics of this movement. The rotation of the radius and ulna occurs mostly at the proximal end, where the radial head rotates over the radial notch of the ulna. ...
... 4,6,7 Fractures of the distal ulna are common, particularly when associated with distal radial fractures. 2,20,[23][24][25][27][28][29][30][31][32][33][34] Approximately 60% of distal radial fractures have an associated ulna styloid fracture. 28,31 This combination of distal radial fractures and ulna styloid fractures can lead to distal radioulnar joint instability, chronic pain, misalignment, and loss of wrist function. ...
... 28,31 This combination of distal radial fractures and ulna styloid fractures can lead to distal radioulnar joint instability, chronic pain, misalignment, and loss of wrist function. 2,20,24,25,[30][31][32][33][34] To obtain an orthogonal projection of the ulna, position the lateral wrist by externally rotating the shoulder to ensure that the ulna and the radius move through the full 90° of rotation. 3,[6][7][8][9]15,35 Editorial Alternative Positioning Approach to a True Lateral Wrist remaining carpal bones to align. ...
... It is the most important dorsal extrinsic ligament of the wrist, stabilizing the lunate bone during the flexion extension. 2 During ultrasound imaging, it is possible to visualize the cross-section of this ligament (circular or elliptical), just above the lunate bone and/or the radiolunate joint (Fig. 1A). ...
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A 35-year-old male patient was seen because of pain and functional limitation in the left wrist for the last 2 months. The pain was worse at night and during gym training especially weightlifting. He denied any major trauma and declared that previous low-level laser therapy had been partially effective. Results of physical examination revealed painful and limited left wrist movements in all ranges especially during dorsiflexion. There was not any joint swelling and instability tests were negative. Ultrasound examination was performed in accordance with the European Musculoskeletal Ultrasound Study Group/Ultrasound Task Force of International Society of Physical and Rehabilitation Medicine basic scanning protocols for wrist and hand1 using a high-frequency linear probe (Fig. 1A). Synovial hypertrophy within the dorsal radiolunate recess was seen with a small amount of fluid in the joint space (Fig. 1B). The peculiar Y-shape of the thickened recess drew our attention to a specific structure of the wrist: the dorsal radiolunotriquetral (RLT) ligament. It was visualized as a hyperechoic circular element just above the radiolunate joint (Fig. 1B). Extensor compartments were otherwise normal. A combination of a wrist orthosis and an oral nonsteroidal anti-inflammatory drug was prescribed for 10 days, followed by a personalized rehabilitation program with stretching exercises. After 3 wks, the patient reported significant pain relief with substantial improvement in the wrist range of motions. The dorsal RLT ligament extends from Lister's tubercle to the triquetral bone crossing the radiolunate joint dorsally and diagonally (Fig. 1A). It is the most important dorsal extrinsic ligament of the wrist, stabilizing the lunate bone during the flexion extension. During ultrasound imaging, it is possible to visualize the cross-section of this ligament (circular or elliptical), just above the lunate bone and/or the radiolunate joint (Fig. 1A). Joint fluid and synovial hypertrophy of the dorsal radiocarpal recess are common sonographic findings during scanning for painful wrists, usually in inflammatory diseases and/or overuse syndromes. In our case, the overtraining in the gym and the repetitive dorsiflexion movements of the wrist might have probably led to a mechanical conflict between the lunate bone and the dorsal RLT ligament with compression and extra friction of the dorsal radiolunate recess (Fig. 1C). Although this condition can usually be diagnosed clinically, like elsewhere, the utility of ultrasound imaging significantly sheds light into better understanding the mechanism of dorsal wrist impingement.
... It is the most important dorsal extrinsic ligament of the wrist, stabilizing the lunate bone during the flexion extension. 2 During ultrasound imaging, it is possible to visualize the cross-section of this ligament (circular or elliptical), just above the lunate bone and/or the radiolunate joint (Fig. 1A). ...
Article
A 35-year-old male patient was seen because of pain and functional limitation in the left wrist for the last 2 months. The pain was worse at night and during gym training especially weightlifting. He denied any major trauma and declared that previous low-level laser therapy had been partially effective. Results of physical examination revealed painful and limited left wrist movements in all ranges especially during dorsiflexion. There was not any joint swelling and instability tests were negative. Ultrasound examination was performed in accordance with the European Musculoskeletal Ultrasound Study Group/Ultrasound Task Force of International Society of Physical and Rehabilitation Medicine basic scanning protocols for wrist and hand1 using a high-frequency linear probe (Fig. 1A). Synovial hypertrophy within the dorsal radiolunate recess was seen with a small amount of fluid in the joint space (Fig. 1B). The peculiar Y-shape of the thickened recess drew our attention to a specific structure of the wrist: the dorsal radiolunotriquetral (RLT) ligament. It was visualized as a hyperechoic circular element just above the radiolunate joint (Fig. 1B). Extensor compartments were otherwise normal. A combination of a wrist orthosis and an oral nonsteroidal anti-inflammatory drug was prescribed for 10 days, followed by a personalized rehabilitation program with stretching exercises. After 3 wks, the patient reported significant pain relief with substantial improvement in the wrist range of motions. The dorsal RLT ligament extends from Lister's tubercle to the triquetral bone crossing the radiolunate joint dorsally and diagonally (Fig. 1A). It is the most important dorsal extrinsic ligament of the wrist, stabilizing the lunate bone during the flexion extension. During ultrasound imaging, it is possible to visualize the cross-section of this ligament (circular or elliptical), just above the lunate bone and/or the radiolunate joint (Fig. 1A). Joint fluid and synovial hypertrophy of the dorsal radiocarpal recess are common sonographic findings during scanning for painful wrists, usually in inflammatory diseases and/or overuse syndromes. In our case, the overtraining in the gym and the repetitive dorsiflexion movements of the wrist might have probably led to a mechanical conflict between the lunate bone and the dorsal RLT ligament with compression and extra friction of the dorsal radiolunate recess (Fig. 1C). Although this condition can usually be diagnosed clinically, like elsewhere, the utility of ultrasound imaging significantly sheds light into better understanding the mechanism of dorsal wrist impingement.
... Radial-sided wrist pain can present a diagnostic challenge for radiologists and other clinicians as this can be related to bone, cartilage, ligament, tendon, muscle or neurovascular bundle injury. This symptom carries with it a long list of differential diagnoses, including tendinopathy, tendon tear or rupture, ligamentous injury or instability, acute fracture or fracture non-union, degenerative arthritis, and ganglion cyst [8,9]. Radiological workup for radial-sided wrist pain includes plain radiography and arthrography, CT, ultrasound, MRI, CT or MR arthrography, and bone scans in Anthony M Kordahi and Kara L Sarrel Denotes as co-first authors certain circumstances. ...
... Radiological workup for radial-sided wrist pain includes plain radiography and arthrography, CT, ultrasound, MRI, CT or MR arthrography, and bone scans in Anthony M Kordahi and Kara L Sarrel Denotes as co-first authors certain circumstances. For tendon abnormalities, ultrasound and MRI are most useful and are commonly utilized [8,9]. In the literature, the identification of FCRB pathology has been reported with use of MRI, but in 2014, Smith and Kakar also demonstrated the efficacy of ultrasound for initial workup [10]. ...
Article
Anatomical variants of muscle are commonly encountered by surgeons and radiologists. The flexor carpi radialis brevis (FCRB) is an anomalous muscle in the distal forearm with an estimated prevalence of 2–8%. In the literature, there are a few case reports of symptomatic FCRB tenosynovitis without a concomitant tear, and treatment methods described include both conservative and surgical management. We present a case of one patient with radial sided wrist pain and a partial FCRB tear, which to our knowledge is the first case report of a symptomatic FCRB tear. We also review existing literature regarding FCRB anatomy, particularly related to intra-operative dissection and exposure. Identification of an anomalous FCRB on imaging may serve to guide clinicians in their differential diagnosis of radial-sided wrist pain, in which FCRB pathological conditions ought to be included.
... It is composed of the carpal bones, while the bottom of the tunnel consists of the transverse ligament. This ligament band is 3---4 cm wide 1 and from 0.8 to 2.5 mm thick, 2 in a range from 1.3 to 3 mm depending on the point at which it is measured. ...
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Objective To determine if the thickness of the transverse carpal ligament measured by T2 axial magnetic resonance imaging actually influences the onset of carpal tunnel syndrome. Material and method 94 patients between January 2015 and June 2016, of whom 28 had carpal tunnel syndrome, underwent magnetic resonance imaging, 37 with discomfort in different carpus regions without symptoms of carpal tunnel and 29 healthy subjects. Two observers performed 3 measurements in 3 different levels, and in the 3 groups of patients. Results No statistically significant differences in transverse carpal ligament thickness measurements between the carpal tunnel syndrome group and the group without carpal tunnel involvement became apparent, but statistical differences between the control group and the carpal tunnel syndrome group, and between the control group and the group without involvement of the carpal tunnel were observed. In both these groups, the thickness of the transverse ligament was higher than in the control group. Discussion An increase in the thickness of the transverse ligament in was found in this study in subjects with involvement of carpal tunnel syndrome as evidenced by numerous studies in the literature. There is no certain causative factor, but rather a set of facts that make onset of the syndrome possible in a specific group of patients. Conclusion Carpal tunnel syndrome is multifactorial. The thickness of the transverse ligament does not directly affect the onset of symptoms.
... It is composed of the carpal bones, while the bottom of the tunnel consists of the transverse ligament. This ligament band is 3---4 cm wide 1 and from 0.8 to 2.5 mm thick, 2 in a range from 1.3 to 3 mm depending on the point at which it is measured. ...
Article
Full-text available
Objective: To determine if the thickness of the transverse carpal ligament measured by T2 axial magnetic resonance imaging actually influences the onset of carpal tunnel syndrome. Material and method: 94 patients between January 2015 and June 2016, of whom 28 had carpal tunnel syndrome, underwent magnetic resonance imaging, 37 with discomfort in different carpus regions without symptoms of carpal tunnel and 29 healthy subjects. Two observers performed 3 measurements in 3 different levels, and in the 3 groups of patients. Results: No statistically significant differences in transverse carpal ligament thickness measurements between the carpal tunnel syndrome group and the group without carpal tunnel involvement became apparent, but statistical differences between the control group and the carpal tunnel syndrome group, and between the control group and the group without involvement of the carpal tunnel were observed. In both these groups, the thickness of the transverse ligament was higher than in the control group. Discussion: An increase in the thickness of the transverse ligament in was found in this study in subjects with involvement of carpal tunnel syndrome as evidenced by numerous studies in the literature. There is no certain causative factor, but rather a set of facts that make onset of the syndrome possible in a specific group of patients. Conclusion: Carpal tunnel syndrome is multifactorial. The thickness of the transverse ligament does not directly affect the onset of symptoms.
Article
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Purpose: This study aimed to develop and validate an automatic segmentation algorithm for the boundary delineation of ten wrist bones, consisting of eight carpal and two distal forearm bones, using a convolutional neural network (CNN). Methods: We performed a retrospective study using adult wrist radiographs. We labeled the ground truth masking of wrist bones, and propose that the Fine Mask R-CNN consisted of wrist regions of interest (ROI) using a Single-Shot Multibox Detector (SSD) and segmentation via Mask R-CNN, plus the extended mask head. The primary outcome was an improvement in the prediction of delineation via the network combined with ground truth masking, and this was compared between two networks through five-fold validations. Results: In total, 702 images were labeled for the segmentation of ten wrist bones. The overall performance (mean (SD] of Dice coefficient) of the auto-segmentation of the ten wrist bones improved from 0.93 (0.01) using Mask R-CNN to 0.95 (0.01) using Fine Mask R-CNN (p < 0.001). The values of each wrist bone were higher when using the Fine Mask R-CNN than when using the alternative (all p < 0.001). The value derived for the distal radius was the highest, and that for the trapezoid was the lowest in both networks. Conclusion: Our proposed Fine Mask R-CNN model achieved good performance in the automatic segmentation of ten overlapping wrist bones derived from adult wrist radiographs.
Article
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The flexor carpi radialis brevis (FCRB) is a very rare anomalous muscle that is usually asymptomatic but may cause various pathologies, such as radial-sided wrist pain. The aim of this study was to determine the prevalence of FCRB in the Turkish population, its location, and sex differences. Forearm, wrist, and hand magnetic resonance images of 849 individuals aged 18–65 years were retrospectively evaluated in this study. The survey found an FCRB prevalence of 4%, with a prevalence of 3.6% among women and of 4.7% among men. However, the difference between the sexes was not statistically significant (p = 0.629). The origin of all 34 FCRBs identified was the distal third of the anterior aspect of the radius; the insertion site of 28 was the second metacarpal bone, whereas that of the remaining 6 was the os trapezium. In conclusion, the data of this study report the prevalence of FCRB for the first time in the Turkish population, which will contribute to radiological and surgical evaluations in the region and help in early and accurate diagnosis of various pathological conditions that may be caused by FCRB.