Semin Musculoskelet Radiol 2008; 12(4): 359-377
DOI: 10.1055/s-0028-1100642
© Thieme Medical Publishers

Ligamentous Injuries of the Wrist

Toshikazu Tanaka1 , Shuhei Ogino2 , 3 , Hiroshi Yoshioka2
  • 1Department of Orthopedic Surgery, Kikkoman General Hospital, Chiba, Japan
  • 2Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
  • 3Department of Orthopedics, Chibaken Saiseikai Hospital, Chiba, Japan
Further Information

Publication History

Publication Date:
18 November 2008 (online)

ABSTRACT

The purpose of this review is to summarize ligamentous injury of the wrist. Triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL) are crucial to wrist stability. Damage to these ligaments causes changes in bone alignment and altered motion pattern. This may cause pain and eventually osteoarthritis. Imaging techniques of the wrist include conventional arthrography, computed tomography (CT) arthrography, conventional magnetic resonance imaging (MRI), and MR arthrography. Especially, MRI plays an important role in the assessment of TFCC, SLL, and LTL. Therefore, special attention is drawn to normal and abnormal MR imaging appearance of these ligaments in this review. Variety of treatment options dependent on classification of TFCC and ligamentous injury as well as role of imaging in the patient treatment are also discussed.

REFERENCES

  • 1 Viegas S F, Ballantyne G. Attritional lesions of the wrist joint.  J Hand Surg [Am]. 1987;  12 1025-1029
  • 2 Bille B, Harley B, Cohen H. A comparison of CT arthrography of the wrist to findings during wrist arthroscopy.  J Hand Surg [Am]. 2007;  32 834-841
  • 3 Levinsohn E M, Rosen I D, Palmer A K. Wrist arthrography: value of the three-compartment injection method.  Radiology. 1991;  179 231-239
  • 4 Metz V M, Mann F A, Gilula L A. Three-compartment wrist arthrography: correlation of pain site with location of uni- and bidirectional communications.  AJR Am J Roentgenol. 1993;  160 819-822
  • 5 Metz V M, Mann F A, Gilula L A. Lack of correlation between site of wrist pain and location of noncommunicating defects shown by three-compartment wrist arthrography.  AJR Am J Roentgenol. 1993;  160 1239-1243
  • 6 Theumann N, Favarger N, Schnyder P, Meuli R. Wrist ligament injuries: value of post-arthrography computed tomography.  Skeletal Radiol. 2001;  30 88-93
  • 7 Schmid M R, Schertler T, Pfirrmann C W et al.. Interosseous ligament tears of the wrist: comparison of multi-detector row CT arthrography and MR imaging.  Radiology. 2005;  237 1008-1013
  • 8 Horton M G, Timins M E. MR imaging of injuries to the small joints.  Radiol Clin North Am. 1997;  35 671-700
  • 9 Imaeda T, Nakamura R, Shionoya K, Makino N. Ulnar impaction syndrome: MR imaging findings.  Radiology. 1996;  201 495-500
  • 10 Timins M E, O'Connell S E, Erickson S J, Oneson S R. MR imaging of the wrist: normal findings that may simulate disease.  Radiographics. 1996;  16 987-995
  • 11 Totterman S M, Miller R, Wasserman B, Blebea J S, Rubens D J. Intrinsic and extrinsic carpal ligaments: evaluation by three-dimensional Fourier transform MR imaging.  AJR Am J Roentgenol. 1993;  160 117-123
  • 12 Ashman C J, Farooki S, Abduljalil A M, Chakeres D W. In vivo high resolution coronal MRI of the wrist at 8.0 Tesla.  J Comput Assist Tomogr. 2002;  26 387-391
  • 13 Yoshioka H, Ueno T, Tanaka T, Shindo M, Itai Y. High-resolution MR imaging of triangular fibrocartilage complex (TFCC): comparison of microscopy coils and a conventional small surface coil.  Skeletal Radiol. 2003;  32 575-581
  • 14 Lewis A R, Nolan M J, Hodgson R J et al.. High resolution magnetic resonance imaging of the proximal interphalangeal joints. Correlation with histology and production of a three-dimensional data set.  J Hand Surg [Br]. 1996;  21 488-495
  • 15 Haims A H, Schweitzer M E, Morrison W B et al.. Internal derangement of the wrist: indirect MR arthrography versus unenhanced MR imaging.  Radiology. 2003;  227 701-707
  • 16 Scheck R J, Kubitzek C, Hierner R et al.. The scapholunate interosseous ligament in MR arthrography of the wrist: correlation with non-enhanced MRI and wrist arthroscopy.  Skeletal Radiol. 1997;  26 263-271
  • 17 Palmer A K. Triangular fibrocartilage complex lesions: a classification.  J Hand Surg [Am]. 1989;  14 594-606
  • 18 Haims A H, Schweitzer M E, Morrison W B et al.. Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist.  AJR Am J Roentgenol. 2002;  178 419-422
  • 19 Cerezal L, del Pinal F, Abascal F, Garcia-Valtuille R, Pereda T, Canga A. Imaging findings in ulnar-sided wrist impaction syndromes.  Radiographics. 2002;  22 105-121
  • 20 Escobedo E M, Bergman A G, Hunter J C. MR imaging of ulnar impaction.  Skeletal Radiol. 1995;  24 85-90
  • 21 Nagle D J. Laser-assisted wrist arthroscopy.  Hand Clin. 1999;  15 495-499 ix
  • 22 De Smet L, De Ferm A, Steenwerckx A, Dauwe D, Zachee B, Fabry G. Arthroscopic treatment of triangular fibrocartilage complex lesions of the wrist.  Acta Orthop Belg. 1996;  62 8-13
  • 23 Menon J, Wood V E, Schoene H R, Frykman G K, Hohl J C, Bestard E A. Isolated tears of the triangular fibrocartilage of the wrist: results of partial excision.  J Hand Surg [Am]. 1984;  9 527-530
  • 24 Bednar J M. Arthroscopic treatment of triangular fibrocartilage tears.  Hand Clin. 1999;  15 479-488 ix
  • 25 Osterman A L. Arthroscopic debridement of triangular fibrocartilage complex tears.  Arthroscopy. 1990;  6 120-124
  • 26 de Araujo W, Poehling G G, Kuzma G R. New Tuohy needle technique for triangular fibrocartilage complex repair: preliminary studies.  Arthroscopy. 1996;  12 699-703
  • 27 Trumble T E, Gilbert M, Vedder N. Ulnar shortening combined with arthroscopic repairs in the delayed management of triangular fibrocartilage complex tears.  J Hand Surg [Am]. 1997;  22 807-813
  • 28 Trumble T E, Gilbert M, Vedder N. Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair.  J Hand Surg [Am]. 1997;  22 57-65
  • 29 Whipple T L, Cooney III W P, Osterman A L, Viegas S F. Wrist arthroscopy.  Instr Course Lect. 1995;  44 139-145
  • 30 Yao J, Dantuluri P, Osterman A L. A novel technique of all-inside arthroscopic triangular fibrocartilage complex repair.  Arthroscopy. 2007;  23 1357
  • 31 Hermansdorfer J D, Kleinman W B. Management of chronic peripheral tears of the triangular fibrocartilage complex.  J Hand Surg [Am]. 1991;  16 340-346
  • 32 Chou K H, Sarris I K, Sotereanos D G. Suture anchor repair of ulnar-sided triangular fibrocartilage complex tears.  J Hand Surg [Br]. 2003;  28 546-550
  • 33 Nakamura T, Nakao Y, Ikegami H, Sato K, Takayama S. Open repair of the ulnar disruption of the triangular fibrocartilage complex with double three-dimensional mattress suturing technique.  Tech Hand Up Extrem Surg. 2004;  8 116-123
  • 34 Cooney W P, Linscheid R L, Dobyns J H. Triangular fibrocartilage tears.  J Hand Surg [Am]. 1994;  19 143-154
  • 35 Osterman A L, Terrill R G. Arthroscopic treatment of TFCC lesions.  Hand Clin. 1991;  7 277-281
  • 36 Bednar J M, Osterman A L. The role of arthroscopy in the treatment of traumatic triangular fibrocartilage injuries.  Hand Clin. 1994;  10 605-614
  • 37 Fellinger M, Peicha G, Seibert F J, Grechenig W. Radial avulsion of the triangular fibrocartilage complex in acute wrist trauma: a new technique for arthroscopic repair.  Arthroscopy. 1997;  13 370-374
  • 38 Jantea C L, Baltzer A, Ruther W. Arthroscopic repair of radial-sided lesions of the triangular fibrocartilage complex.  Hand Clin. 1995;  11 31-36
  • 39 Short W. Triangular fibrocartilage complex injuries and ulnar impaction syndrome. In: Berger RA, Weiss A-P Hand Surgery. Philadelphia, Pa; Lippincott Williams & Wilkins 2004: 355-380
  • 40 Tatebe M, Horii E, Nakao E et al.. Repair of the triangular fibrocartilage complex after ulnar-shortening osteotomy: second-look arthroscopy.  J Hand Surg [Am]. 2007;  32 445-449
  • 41 Totterman S M, Miller R J, McCance S E, Meyers S P. Lesions of the triangular fibrocartilage complex: MR findings with a three-dimensional gradient-recalled-echo sequence.  Radiology. 1996;  199 227-232
  • 42 Potter H G, Asnis-Ernberg L, Weiland A J, Hotchkiss R N, Peterson M G, McCormack Jr R R. 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 1675-1684
  • 43 Dailey S W, Palmer A K. The role of arthroscopy in the evaluation and treatment of triangular fibrocartilage complex injuries in athletes.  Hand Clin. 2000;  16 461-476
  • 44 Blazar P E, Chan P S, Kneeland J B, Leatherwood D, Bozentka D J, Kowalchick R. The effect of observer experience on magnetic resonance imaging interpretation and localization of triangular fibrocartilage complex lesions.  J Hand Surg [Am]. 2001;  26 742-748
  • 45 Kato H, Nakamura R, Shionoya K, Makino N, Imaeda T. Does high-resolution MR imaging have better accuracy than standard MR imaging for evaluation of the triangular fibrocartilage complex?.  J Hand Surg [Br]. 2000;  25 487-491
  • 46 Tanaka T, Yoshioka H, Ueno T, Shindo M, Ochiai N. Comparison between high-resolution MRI with a microscopy coil and arthroscopy in triangular fibrocartilage complex injury.  J Hand Surg [Am]. 2006;  31 1308-1314
  • 47 Daunt N. Magnetic resonance imaging of the wrist: anatomy and pathology of interosseous ligaments and the triangular fibrocartilage complex.  Curr Probl Diagn Radiol. 2002;  31 158-176
  • 48 Walsh J J, Berger R A, Cooney W P. Current status of scapholunate interosseous ligament injuries.  J Am Acad Orthop Surg. 2002;  10 32-42
  • 49 Totterman S M, Miller R J. Scapholunate ligament: normal MR appearance on three-dimensional gradient-recalled-echo images.  Radiology. 1996;  200 237-241
  • 50 Steinbach L S, Palmer W E, Schweitzer M E. Special focus session. MR arthrography.  Radiographics. 2002;  22 1223-1246
  • 51 Schweitzer M E, Brahme S K, Hodler J et al.. Chronic wrist pain: spin-echo and short tau inversion recovery MR imaging and conventional and MR arthrography.  Radiology. 1992;  182 205-211
  • 52 Manton G L, Schweitzer M E, Weishaupt D et al.. Partial interosseous ligament tears of the wrist: difficulty in utilizing either primary or secondary MRI signs.  J Comput Assist Tomogr. 2001;  25 671-676
  • 53 Smith D K. Scapholunate interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists.  Radiology. 1994;  192 217-221
  • 54 Geissler W B, Freeland A E, Savoie F H, McIntyre L W, Whipple T L. Intercarpal soft-tissue lesions associated with an intraarticular fracture of the distal end of the radius.  J Bone Joint Surg Am. 1996;  78 357-365
  • 55 Watson H K, Weinzweig J, Zeppieri J. The natural progression of scaphoid instability.  Hand Clin. 1997;  13 39-49
  • 56 Garcia-Elias M, Lluch A, Stanley J. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique.  J Hand Surg [Am]. 2006;  31 125-134
  • 57 Kozin S H. The role of arthroscopy in scapholunate instability.  Hand Clin. 1999;  15 435-444
  • 58 Palmer A K, Dobyns J H, Linscheid R L. Management of post-traumatic instability of the wrist secondary to ligament rupture.  J Hand Surg [Am]. 1978;  3 507-532
  • 59 King R J. Scapholunate diastasis associated with a Barton fracture treated by manipulation, or Terry-Thomas and the wine waiter.  J R Soc Med. 1983;  76 421-423
  • 60 Tang J B, Shi D, Gu Y Q, Zhang Q G. Can cast immobilization successfully treat scapholunate dissociation associated with distal radius fractures?.  J Hand Surg [Am]. 1996;  21 583-590
  • 61 O'Brien E T. Acute fractures and dislocations of the carpus.  Orthop Clin North Am. 1984;  15 237-258
  • 62 Peicha G, Seibert F, Fellinger M, Grechenig W, Schippinger G. Lesions of the scapholunate ligaments in acute wrist trauma—arthroscopic diagnosis and minimally invasive treatment.  Knee Surg Sports Traumatol Arthrosc. 1997;  5 176-183
  • 63 Weiss A P, Sachar K, Glowacki K A. Arthroscopic debridement alone for intercarpal ligament tear.  J Hand Surg [Am]. 1997;  22 344-349
  • 64 Darlis N A, Kaufmann R A, Giannoulis F, Sotereanos D G. Arthroscopic debridement and closed pinning for chronic dynamic scapholunate instability.  J Hand Surg [Am]. 2006;  31 418-424
  • 65 Hirsh L, Sodha S, Bozentka D, Monaghan B, Steingerg D, Beredjiklian P. Arthroscopic electrothermal collagen shrinkage for symptomatic laxity of the scapholunate interosseous ligament.  J Hand Surg [Br]. 2005;  30 643-647
  • 66 Ruch D S, Poehling G G. Arthroscopic management of partial scapholunate and lunotriquetral injuries of the wrist.  J Hand Surg [Am]. 1996;  21 412-417
  • 67 Bickert B, Sauerbier M, Germann G. Scapholunate ligament repair using the Mitek bone anchor.  J Hand Surg [Br]. 2000;  25 188-192
  • 68 Schweizer A, Steiger R. Long-term results after repair and augmentation ligamentoplasty of rotatory subluxation of the scaphoid.  J Hand Surg [Am]. 2002;  27 674-684
  • 69 Blatt G. Capsulodesis in reconstructive hand surgery. Dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna.  Hand Clin. 1987;  3 81-102
  • 70 Deshmukh S C, Givissis P, Belloso D, Stanley J K, Trail I A. Blatt's capsulodesis for chronic scapholunate dissociation.  J Hand Surg [Br]. 1999;  24 215-220
  • 71 Shih J T, Lee H M, Hou Y T, Horng S T, Tan C M. Dorsal capsulodesis and ligamentoplasty for chronic pre-dynamic and dynamic scapholunate dissociation.  Hand Surg. 2003;  8 173-178
  • 72 Minami A, Kato H, Iwasaki N. Treatment of scapholunate dissociation: ligamentous repair associated with modified dorsal capsulodesis.  Hand Surg. 2003;  8 1-6
  • 73 Moran S L, Cooney W P, Berger R A, Strickland J. Capsulodesis for the treatment of chronic scapholunate instability.  J Hand Surg [Am]. 2005;  30 16-23
  • 74 Gajendran V K, Peterson B, Slater R J, Szabo R M. Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation.  J Hand Surg [Am]. 2007;  32 1323-1333
  • 75 Dobyns J H, Linscheid R, Chao E. Traumatic instability of the wrist.  Instr Course Lect. 1975;  24 182-199
  • 76 Almquist E E, Bach A W, Sack J T, Fuhs S E, Newman D M. Four-bone ligament reconstruction for treatment of chronic complete scapholunate separation.  J Hand Surg [Am]. 1991;  16 322-327
  • 77 Pettersson K, Wagnsjö P. Arthrodesis for chronic static scapholunate dissociation: a prospective study in 12 patients.  Scand J Plast Reconstr Surg Hand Surg. 2004;  38 166-171
  • 78 Viegas S F, Patterson R M, Peterson PD, et al.. Evaluation of the biomechanical efficacy of limited intercarpal fusions for the treatment of scapho-lunate dissociation.  J Hand Surg [Am]. 1990;  15 120-128
  • 79 Hom S, Ruby L. Attempted scapholunate arthrodesis for chronic scapholunate dissociation.  J Hand Surg [Am]. 1991;  16 334-339
  • 80 Watson H K, Belniak R, Garcia-Elias M. Treatment of scapholunate dissociation: preferred treatment—STT fusion vs other methods.  Orthopedics. 1991;  14 365-368
  • 81 Fortin P T, Louis D S. Long-term follow-up of scaphoid-trapezium-trapezoid arthrodesis.  J Hand Surg [Am]. 1993;  18 675-681
  • 82 Pisano S M, Peimer C A, Wheeler D R, Sherwin F. Scaphocapitate intercarpal arthrodesis.  J Hand Surg [Am]. 1991;  16 328-333
  • 83 Watson H K, Ballet F L. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis.  J Hand Surg [Am]. 1984;  9 358-365
  • 84 Krakauer J D, Bishop A T, Cooney W P. Surgical treatment of scapholunate advanced collapse.  J Hand Surg [Am]. 1994;  19 751-759
  • 85 Manuel J, Moran S. The diagnosis and treatment of scapholunate instability.  Orthop Clin North Am. 2007;  38 261-277
  • 86 Diao E, Andrews A, Beall M. Proximal row carpectomy.  Hand Clin. 2005;  21 553-559
  • 87 Tomaino M M, Miller R J, Cole I, Burton R I. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision?.  J Hand Surg [Am]. 1994;  19 134-142
  • 88 Jones W A. Beware the sprained wrist: the incidence and diagnosis of scapholunate instability.  J Bone Joint Surg Br. 1988;  70 293-297
  • 89 Cautilli G P, Wehbe M A. Scapho-lunate distance and cortical ring sign.  J Hand Surg [Am]. 1991;  16 501-503
  • 90 Linscheid R L, Dobyns J H, Beabout J W, Bryan R S. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics.  J Bone Joint Surg Am. 1972;  54 1612-1632
  • 91 Palmer A K, Levinsohn E M, Kuzma G R. Arthrography of the wrist.  J Hand Surg [Am]. 1983;  8 15-23
  • 92 Gilula L A, Totty W G, Weeks P M. Wrist arthrography. The value of fluoroscopic spot viewing.  Radiology. 1983;  146 555-556
  • 93 Morley J, Bidwell J, Bransby-Zachary M. A comparison of the findings of wrist arthroscopy and magnetic resonance imaging in the investigation of wrist pain.  J Hand Surg [Br]. 2001;  26 544-546
  • 94 Moser T, Dosch J, Moussaoui A, Dietemann J. Wrist ligament tear: evaluation of MRI and combined MDCT and MR arthrography.  AJR Am J Roentgenol. 2007;  188 1278-1286
  • 95 Yoshioka H, Tanaka T, Ueno T, Shindo M, Lang P, Winalski C. High-resolution MR imaging of the proximal zone of the lunotriquetral ligament with a microscopy coil.  Skeletal Radiol. 2006;  35 288-294
  • 96 O'Meeghan C J, Stuart W, Mamo V, Stanley J K, Trail I A. The natural history of an untreated isolated scapholunate interosseus ligament injury.  J Hand Surg [Br]. 2003;  28 307-310
  • 97 Clark D L, von Schroeder H P. Scapholunate ligament injury: the natural history.  Can J Surg. 2004;  47 298-299
  • 98 Shin A Y, Battaglia M J, Bishop A T. Lunotriquetral instability: diagnosis and treatment.  J Am Acad Orthop Surg. 2000;  8 170-179
  • 99 Yoshioka H, Ueno T, Tanaka T, Shindo M, Lang P. High-resolution MR imaging of the intercarpal ligaments with a microscopy coil. Presented at the RSNA 90th Scientific Assembly and Annual Meeting 2004
  • 100 Zlatkin M B, Chao P C, Osterman A L, Schnall M D, Dalinka M K, Kressel H Y. Chronic wrist pain: evaluation with high-resolution MR imaging.  Radiology. 1989;  173 723-729
  • 101 Johnstone D J, Thorogood S, Smith W H, Scott T D. A comparison of magnetic resonance imaging and arthroscopy in the investigation of chronic wrist pain.  J Hand Surg [Br]. 1997;  22 714-718
  • 102 Smith D K, Snearly W N. Lunotriquetral interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists.  Radiology. 1994;  191 199-202
  • 103 Reagan D S, Linscheid R L, Dobyns J H. Lunotriquetral sprains.  J Hand Surg [Am]. 1984;  9 502-514
  • 104 Shih J T, Lee H M, Hou Y T, Tan C M. Arthroscopically-assisted reduction of intra-articular fractures and soft tissue management of distal radius.  Hand Surg. 2001;  6 127-135
  • 105 Shin A Y, Weinstein L P, Berger R A, Bishop A T. Treatment of isolated injuries of the lunotriquetral ligament.  J Bone Joint Surg Br. 2001;  83 1023-1028
  • 106 De Smet L, Janssens I, Ransbeeck H. Chronic lunotriquetral dissociation: dorsal capsular reinforcement with a retinaculum flap.  Acta Orthop Belg. 2003;  69 515-517
  • 107 Vandesande W, De Smet L, Van Ransbeeck H. Lunotriquetral arthrodesis, a procedure with a high failure rate.  Acta Orthop Belg. 2001;  67 361-367
  • 108 Sennwald G R, Fischer M, Mondi P. Lunotriquetral arthrodesis. a controversial procedure.  J Hand Surg [Br]. 1995;  20 755-760
  • 109 Pin P G, Young V L, Gilula L A, Weeks P M. Management of chronic lunotriquetral ligament tears.  J Hand Surg [Am]. 1989;  14 77-83
  • 110 Nelson D L, Manske P R, Pruitt D L, Gilula L A, Martin R A. Lunotriquetral arthrodesis.  J Hand Surg [Am]. 1993;  18 1113-1120
  • 111 Schoonhoven J, Prommersberger K, Schmitt R. Traumatic disruption of a fibrocartilage lunate-triquetral coalition.  Hand Surg. 2001;  6 103-108
  • 112 Roth J H, Haddad R G. Radiocarpal arthroscopy and arthrography in the diagnosis of ulnar wrist pain.  Arthroscopy. 1986;  2 234-243

Hiroshi YoshiokaM.D. Ph.D. 

Brigham and Women's Hospital

75 Francis St., Boston, MA 02115

Email: hyoshioka@partners.org