Download PDF
Semin Musculoskelet Radiol 2021; 25(02): 304-310
DOI: 10.1055/s-0041-1730398
Review Article

Carpal Instability: II. Imaging

Nina Hesse
1   Department of Radiology, LMU, Munich, Germany
,
Rainer Schmitt
1   Department of Radiology, LMU, Munich, Germany
2   Department of Radiology, University Hospital Würzburg, Würzburg, Germany
,
Johanna Luitjens
1   Department of Radiology, LMU, Munich, Germany
,
Jan-Peter Grunz
2   Department of Radiology, University Hospital Würzburg, Würzburg, Germany
,
Elisabeth Maria Haas-Lützenberger
3   Department for Hand, Plastic and Aesthetic Surgery, LMU, Munich, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Beyond clinical examination, the various forms of carpal instability are assessed with radiologic methods and arthroscopy. For this purpose, the imaging demand for spatial and contrast resolution is particularly high because of the small ligamentous structures involved. The entities of carpal instability are classified into degrees of severity. Early (dynamic) forms of instability can either be indirectly detected with X-ray stress views and cineradiography or by direct visualization of ruptured ligaments in high-resolution magnetic resonance (MR) imaging and MR or computed tomography (CT) arthrography, with the latter the standard of reference in imaging. Advanced (static) forms of carpal instability are sufficiently well detected on radiographs; visualization of early carpal osteoarthritis is superior on CT. To prevent disability of the hand, the radiologist has to provide an early and precise diagnosis. This case-based review highlights the imaging procedures suitable for detection and classification of carpal instability.

Keywords

computed tomography arthrography - cineradiography - instability - magnetic resonance imaging - magnetic resonance arthrography

Supplementary Material



Publication History

Article published online:
09 August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Definition of carpal instability. The Anatomy and Biomechanics Committee of the International Federation of Societies for Surgery of the Hand. J Hand Surg Am 1999; 24 (04) 866-867
    CrossrefPubMedGoogle Scholar
  • 2 Amadio PC. Carpal kinematics and instability: a clinical and anatomic primer. Clin Anat 1991; 4: 1-12
    CrossrefPubMedGoogle Scholar
  • 3 Larsen CF, Amadio PC, Gilula LA, Hodge JC. Analysis of carpal instability: I. Description of the scheme. J Hand Surg Am 1995; 20 (05) 757-764
    CrossrefPubMedGoogle Scholar
  • 4 Watson HK, Black DM. Instabilities of the wrist. Hand Clin 1987; 3 (01) 103-111
    CrossrefPubMedGoogle Scholar
  • 5 Schmitt R, Hesse N, Gietzen C. Carpal instability: I. Pathoanatomy. Semin Musculoskelet Radiol 2021; 25: xx-xx
    PubMedGoogle Scholar
  • 6 Epner RA, Bowers WH, Guilford WB. Ulnar variance—the effect of wrist positioning and roentgen filming technique. J Hand Surg Am 1982; 7 (03) 298-305
    CrossrefPubMedGoogle Scholar
  • 7 Levis CM, Yang Z, Gilula LA. Validation of the extensor carpi ulnaris groove as a predictor for the recognition of standard posteroanterior radiographs of the wrist. J Hand Surg Am 2002; 27 (02) 252-257
    CrossrefPubMedGoogle Scholar
  • 8 Yang Z, Mann FA, Gilula LA, Haerr C, Larsen CF. Scaphopisocapitate alignment: criterion to establish a neutral lateral view of the wrist. Radiology 1997; 205 (03) 865-869
    CrossrefPubMedGoogle Scholar
  • 9 Gilula LA. Carpal injuries: analytic approach and case exercises. AJR Am J Roentgenol 1979; 133 (03) 503-517
    CrossrefPubMedGoogle Scholar
  • 10 Linn MR, Mann FA, Gilula LA. Imaging the symptomatic wrist. Orthop Clin North Am 1990; 21 (03) 515-543
    CrossrefPubMedGoogle Scholar
  • 11 Pirela-Cruz MA, Hansen MF. Assessment of midcarpal deformity of the wrist using the triangulation method. J Hand Surg Am 2003; 28 (06) 938-942
    CrossrefPubMedGoogle Scholar
  • 12 Schernberg F. Roentgenographic examination of the wrist: a systematic study of the normal, lax and injured wrist. Part 1: The standard and positional views. J Hand Surg [Br] 1990; 15 (02) 210-219
    CrossrefPubMedGoogle Scholar
  • 13 Vance RM, Gelberman RH, Braun RM. Chronic bilateral scapholunate dissociation without symptoms. J Hand Surg Am 1979; 4 (02) 178-180
    CrossrefPubMedGoogle Scholar
  • 14 Protas JM, Jackson WT. Evaluating carpal instabilities with fluoroscopy. AJR Am J Roentgenol 1980; 135 (01) 137-140
    CrossrefPubMedGoogle Scholar
  • 15 Pliefke J, Stengel D, Rademacher G, Mutze S, Ekkernkamp A, Eisenschenk A. Diagnostic accuracy of plain radiographs and cineradiography in diagnosing traumatic scapholunate dissociation. Skeletal Radiol 2008; 37 (02) 139-145
    CrossrefPubMedGoogle Scholar
  • 16 Saupe N, Prüssmann KP, Luechinger R, Bösiger P, Marincek B, Weishaupt D. MR imaging of the wrist: comparison between 1.5- and 3-T MR imaging—preliminary experience. Radiology 2005; 234 (01) 256-264
    CrossrefPubMedGoogle Scholar
  • 17 Totterman SM, Miller R, Wasserman B, Blebea JS, Rubens DJ. Intrinsic and extrinsic carpal ligaments: evaluation by three-dimensional Fourier transform MR imaging. AJR Am J Roentgenol 1993; 160 (01) 117-123
    CrossrefPubMedGoogle Scholar
  • 18 Özkan S, Kheterpal A, Palmer WE, Chen NC. Dorsal extrinsic ligament injury and static scapholunate diastasis on magnetic resonance imaging scans. J Hand Surg Am 2019; 44 (08) 641-648
    CrossrefPubMedGoogle Scholar
  • 19 Stäbler A, Kohz P, Baumeister R. et al. Diagnosis of injuries of the carpal ligaments and capsules using contrast-enhanced MRI. Radiologe 1995; 35: 90
    PubMedGoogle Scholar
  • 20 Toms AP, Chojnowski A, Cahir JG. Midcarpal instability: a radiological perspective. Skeletal Radiol 2011; 40 (05) 533-541
    CrossrefPubMedGoogle Scholar
  • 21 Metz VM, Mann FA, Gilula LA. Three-compartment wrist arthrography: correlation of pain site with location of uni- and bidirectional communications. AJR Am J Roentgenol 1993; 160 (04) 819-822
    CrossrefPubMedGoogle Scholar
  • 22 Linkous MD, Pierce SD, Gilula LA. Scapholunate ligamentous communicating defects in symptomatic and asymptomatic wrists: characteristics. Radiology 2000; 216 (03) 846-850
    CrossrefPubMedGoogle Scholar
  • 23 Cerezal L, Abascal F, García-Valtuille R, Del Piñal F. Wrist MR arthrography: how, why, when. Radiol Clin North Am 2005; 43 (04) 709-731 , viii
    CrossrefPubMedGoogle Scholar
  • 24 Theumann N, Favarger N, Schnyder P, Meuli R. Wrist ligament injuries: value of post-arthrography computed tomography. Skeletal Radiol 2001; 30 (02) 88-93
    CrossrefPubMedGoogle Scholar
  • 25 Scheck RJ, 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 (05) 263-271
    CrossrefPubMedGoogle Scholar
  • 26 Schmitt R, Christopoulos G, Meier R. et al. Direct MR arthrography of the wrist in comparison with arthroscopy: a prospective study on 125 patients. [in German]. Röfo Fortschr Geb Röntgenstr Nuklearmed 2003; 175 (07) 911-919
    PubMedGoogle Scholar
  • 27 Moser T, Dosch J-C, Moussaoui A, Dietemann JL. Wrist ligament tears: evaluation of MRI and combined MDCT and MR arthrography. AJR Am J Roentgenol 2007; 188 (05) 1278-1286
    CrossrefPubMedGoogle Scholar
  • 28 Lee RK, Griffith JF, Ng AW. et al. Intrinsic carpal ligaments on MR and multidetector CT arthrography: comparison of axial and axial oblique planes. Eur Radiol 2017; 27 (03) 1277-1285
    CrossrefPubMedGoogle Scholar
  • 29 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
    CrossrefPubMedGoogle Scholar
  • 30 Grunz J. Carpal instability: III. Osteoarthritis. Semin Musculoskelet Radiol 2021; 25: xx-xx
    PubMedGoogle Scholar
  • 31 Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 1972; 54 (08) 1612-1632
    CrossrefPubMedGoogle Scholar
  • 32 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
    CrossrefPubMedGoogle Scholar
  • 33 Klempka A, Wagner M, Fodor S, Prommersberger KJ, Uder M, Schmitt R. Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography. Eur Radiol 2016; 26 (03) 722-732
    CrossrefPubMedGoogle Scholar
  • 34 Mitsuyasu H, Patterson RM, Shah MA, Buford WL, Iwamoto Y, Viegas SF. The role of the dorsal intercarpal ligament in dynamic and static scapholunate instability. J Hand Surg Am 2004; 29 (02) 279-288
    CrossrefPubMedGoogle Scholar
  • 35 Haims AH, Schweitzer ME, Morrison WB. et al. Internal derangement of the wrist: indirect MR arthrography versus unenhanced MR imaging. Radiology 2003; 227 (03) 701-707
    CrossrefPubMedGoogle Scholar
  • 36 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
    CrossrefPubMedGoogle Scholar
  • 37 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
    CrossrefPubMedGoogle Scholar
  • 38 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
    CrossrefPubMedGoogle Scholar
  • 39 Rayhack JM, Linscheid RL, Dobyns JH, Smith JH. Posttraumatic ulnar translation of the carpus. J Hand Surg Am 1987; 12 (02) 180-189
    CrossrefPubMedGoogle Scholar
  • 40 Resnick D, Niwayama G. Carpal instability in rheumatoid arthritis and calcium pyrophosphate deposition disease. Pathogenesis and roentgen appearance. Ann Rheum Dis 1977; 36 (04) 311-318
    CrossrefPubMedGoogle Scholar
  • 41 Taleisnik J. The Wrist. New York, NY: Churchill Livingstone; 1985
    Google Scholar
  • 42 Ruby LK, Cooney III WP, An KN, Linscheid RL, Chao EY. Relative motion of selected carpal bones: a kinematic analysis of the normal wrist. J Hand Surg Am 1988; 13 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 43 Lichtman DM, Bruckner JD, Culp RW, Alexander CE. Palmar midcarpal instability: results of surgical reconstruction. J Hand Surg Am 1993; 18 (02) 307-315
    CrossrefPubMedGoogle Scholar
  • 44 Garcia-Elias M. The non-dissociative clunking wrist: a personal view. J Hand Surg Eur Vol 2008; 33 (06) 698-711
    CrossrefPubMedGoogle Scholar