Abstract
Carpal stability depends on the integrity of both intra-articular and intracapsular
carpal ligaments. In this review, the role of the radial-sided and ulnar-sided extrinsic
and intrinsic ligaments is described, as well as their advanced imaging using magnetic
resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI)
with three-dimensional (3D) scapholunate complex sequences and thin slices. In the
last decade, the new concept of a so-called “scapholunate complex” has emerged among
hand surgeons, just as the triangular ligament became known as the triangular fibrocartilage
complex (TFCC).
The scapholunate ligament complex comprises the intrinsic scapholunate (SL), the extrinsic
palmar radiocarpal: radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate
(SRL) ligaments, the extrinsic dorsal radiocarpal (DRC) ligament, the dorsal intercarpal
(DIC) ligament, as well as the dorsal capsular scapholunate septum (DCSS), a more
recently described anatomical structure, and the intrinsic palmar midcarpal scaphotrapeziotrapezoid
(STT) ligament complex. The scapholunate (SL) ligament complex is one of the most
involved in wrist injuries. Its stability depends on primary (SL ligament) and secondary
(RSC, DRC, DIC, STT ligaments) stabilizers.
The gold standard for carpal ligament assessment is still diagnostic arthroscopy for
many hand surgeons. To avoid surgery as a diagnostic procedure, advanced MRI is needed
to detect associated lesions (sprains, midsubstance tears, avulsions and chronic fibrous
infiltrations) of the extrinsic, midcarpal and intrinsic wrist ligaments, which are
demonstrated in this article using 3D and two-dimensional sequences with thin slices
(0.4 and 2 mm thick, respectively).
Keywords
scapholunate complex - extrinsic and intrinsic wrist ligament tears - carpal instability
- 3D magnetic resonance imaging and arthrography
